Is Endomethasin (indomethacin), a nonsteroidal anti-inflammatory drug (NSAID), an NSAID?

Indomethacin is a Nonsteroidal Anti-inflammatory Drug (NSAID)

Yes, endomethasin (indomethacin) is definitely a nonsteroidal anti-inflammatory drug (NSAID). Indomethacin belongs to the indole and indene acetic acid chemical group of NSAIDs 1.

Classification and Pharmacology

Indomethacin is classified as a non-selective NSAID that inhibits both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes 2. This inhibition reduces the production of prostaglandins, which are mediators of inflammation, pain, and fever.

Key pharmacological characteristics include:

• Complete oral absorption with peak plasma concentrations of 1-2 mcg/mL reached within 2 hours of administration 2
• Approximately 90% protein binding to albumin in plasma 3
• Half-life of approximately 4.5 hours 2
• Elimination through renal excretion, metabolism, and biliary excretion 2

Clinical Applications

Indomethacin is used for various inflammatory conditions, including:

• Acute gout arthritis 1
• Rheumatoid arthritis 2
• Ankylosing spondylitis 1
• Osteoarthritis 2

In the management of ankylosing spondylitis, the American College of Rheumatology strongly recommends treatment with NSAIDs, including indomethacin, over no treatment 1. Multiple head-to-head trials have shown that indomethacin is as effective as other NSAIDs for managing pain and stiffness in ankylosing spondylitis 1.

Comparison to Other NSAIDs

Despite its common use as a first-line NSAID for certain conditions like gout, evidence shows that indomethacin has no greater efficacy than other NSAIDs 1. The American College of Physicians guideline states: "Although indomethacin is commonly considered as the first-line NSAID for treatment of acute gout, there is no evidence that it is more efficacious than other NSAIDs, such as naproxen and ibuprofen" 1.

Safety Considerations

Like other NSAIDs, indomethacin carries risks including:

• Gastrointestinal adverse effects (ulceration, bleeding, perforation) 1
• Cardiovascular risks (increased blood pressure, heart failure exacerbation) 1
• Renal effects (reduced renal blood flow) 4

Indomethacin may have more significant drug interactions than some other NSAIDs, particularly with:

• Lithium (increased plasma concentrations) 2
• Probenecid (increased indomethacin levels) 2
• Triamterene (risk of acute renal failure) 2

Clinical Implications

When considering indomethacin use:

1. Choose appropriate patients without contraindications (renal disease, heart failure, cirrhosis)
2. Use the lowest effective dose for the shortest duration
3. Monitor for adverse effects, particularly in elderly patients
4. Consider gastroprotection with proton pump inhibitors in high-risk patients
5. Be aware of potential drug interactions, especially with anticoagulants, lithium, and diuretics

In summary, indomethacin is definitively classified as an NSAID that shares the common mechanism of action, benefits, and risks associated with this drug class.