Description
The ductus arteriosus is typically closed at birth due to the significant increase in oxygen tension that occurs after birth. By inhibiting the synthesis of prostaglandins, indometacin promotes the closure of ductus arteriosus. Arachidonic acid is transformed into PGG2 and PGG2 is transformed into PGH2 by COX-2. Inflammatory stimuli have a high ability to induce the expression of COX-2. By catalyzing the transformation of arachidonic acid into prostaglandin (PG) G2 and PGG2 into PGH2, the COX-1 enzyme contributes to the protection of the gastric mucosa, platelet, and kidney function. Reduced inflammatory responses are brought on by dropping PGE2 levels. PGH2 is further transformed into PGE2 and PGI2 (also known as prostacyclin) through the COX-2-mediated pathway. Through the activation of protein kinase R (PKR) and downstream phosphorylation of eIF2, which prevents protein synthesis, indomethacin has been said to have anticancer and antiviral properties. The cyclo-oxygenase (COX) enzyme, also known as prostaglandin G/H synthase, is irreversibly and non-specifically inhibited by indometacin. It is known that indomethacin inhibits both COX isoforms, but does so more selectively for COX-1, which explains why it has more negative side effects on the stomach than other NSAIDs. Unlike other NSAIDs, indomethacin also prevents phospholipase A2, an enzyme that releases arachidonic acid from phospholipids, from working. It binds to the enzyme's active site and prevents the interaction between the enzyme and its substrate, arachidonic acid. It is located in various organs, including the kidneys, uterus, and the central nervous system. Its antipyretic effects might be brought on by how the hypothalamus reacts to it, increasing peripheral blood flow, causing vasodilation, and causing heat to dissipate as a result. PGE1 widens the ductus arteriosus by relaxing the smooth muscles and preventing the ductus arteriosus from closing. PGE2 plays a role in regulating fever, pain, and inflammation. PGE1 mediates an opposite effect to that of oxygen and is linked to congenital heart malformations in premature infants with patent ductus arteriosus. The analgesic, antipyretic and anti-inflammatory effects of indomethacin as well as adverse reactions associated with the drug occur as a result of decreased prostaglandin synthesis. The exact mechanism of action of indometacin in inducing closure of a patent ductus arteriosus is not fully understood; however, it is thought to be through inhibition of prostaglandin synthesis. There are two known isoforms of COX: COX-1, which is universally present in most body tissues and is involved in the synthesis of prostaglandins and thromboxane A2, and COX-2, which is expressed in response to injury or inflammation.
Dosage
Never take it in larger or smaller amounts or more frequently than your doctor has instructed. One or two times a day is the typical dosage for extended-release capsules. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. If you have any questions, consult your doctor or pharmacist before starting this regimen. If your symptoms are under control, your doctor may start you on an average dose of indomethacin and then lower it. In some circumstances, your doctor might start you on a low dose of indomethacin and gradually increase it, not more frequently than once per week. Two to four times a day, indomethacin liquid and capsules are typically taken. Take indomethacin with food, right after a meal, or with antacids if it is available in capsule, extended-release capsule, or suspension form. There are three oral dosage forms of indomethacin: capsules, extended-release (long-acting) capsules, and suspension. Additionally, indomethacin is occasionally used to treat a specific kind of low blood pressure, to reduce the amount of calcium in the blood, to treat fever, pain, and inflammation brought on by a variety of ailments and injuries, and to relieve these symptoms. Before each use, thoroughly shake the suspension to mix the medication. Do not split, chew, or crush the extended-release capsules; instead, swallow them whole. Take indomethacin every day at roughly the same time. Do not alter the dosage of indomethacin. The risks of using this medication for your condition should be discussed with your doctor. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Unless your doctor tells you otherwise, continue your normal diet. Throughout your treatment, your doctor might adjust the dosage of your medication.
Missed dose
Never combine two doses into one. If it's almost time for your next dose, skip the missed dose and take the medication as soon as you remember.
Overdose
If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. Call 1-800-222-1222 to reach the poison control hotline in the event of an overdose. At https://www.poisonhelp.org/help, you can also find information online. Symptoms of overdose may include the following: nausea vomiting headache dizziness confusion extreme tiredness feeling of numbness, pricking, burning, or creeping on the skin seizures
Storage
However, you should not flush this medication down the toilet. The best way to get rid of your medication is instead through a medication take-back program. As many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Store this medication out of children's reach in the tightly closed, original container. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. Keep it at room temperature, away from sources of extreme heat, and dry (not in the bathroom). To find out about take-back programs in your neighborhood, speak with your pharmacist or get in touch with your city's garbage/recycling department. Always lock safety caps and immediately store medications up and away and out of young children's sight and reach. http://www.upandaway.org Unused medications should be disposed of in special ways to ensure that pets, children, and other people cannot ingest them.
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Gastrointestinal : Nausea, vomiting, indigestion, diarrhea, abdominal distress or pain and constipation. Monitor liver function, kidney function, lung function, blood counts regularly while taking this medication. • Central Nervous System : Headache, dizziness, vertigo, drowsiness, depression and fatigue. Please do write to us ([email protected]) if a drug is missing from our comprehensive drug price list.
In summary Dr Ravichandran said that the 210 patients comprised 102 in the indomethacin group and 108 in the paracetamol group. This centre was ideal for the study as the doctors were enthusiastic and a dedicated ward was available for the study. He went on to prescribe indomethacin to a small number of patients with covid-19, all of whom recovered without hospitalisation, despite having multiple comorbidities including renal disease, diabetes, obesity and advanced age.
Figure 2 shows the timeline for pain scores in two study groups. compared the intravenous administration of morphine and paracetamol among 146 renal colic patients who visited emergency department [8]. the efficacy of celecoxib, also an NSAID, in the management of renal colic was evaluated [15].
Particulate Matter Leads to Indomethacin, Sodium Chloride Recalls One lot of American Regent’s concentrated sodium chloride injections and one lot of Bedford Laboratories’ Indomethacin injections have been recalled due to contamination by particulate matter.