What is the recommended dosing regimen for a 3-day course of indomethacin (Nonsteroidal Anti-Inflammatory Drug - NSAID)?

Indomethacin Dosing for a 3-Day Course

For a standard 3-day course of indomethacin, the recommended dosing is 50 mg three times daily for 2 days, followed by 25 mg three times daily for the third day. 1, 2

Dosing Recommendations by Indication

Acute Gout

• Initial dose: 50 mg three times daily until pain is tolerable 1
• Continue until pain is controlled, then rapidly reduce to complete cessation 2
• Pain relief typically occurs within 2-4 hours; tenderness and heat subside within 24-36 hours 1

HIV-Associated Pruritus

• 25 mg three times daily orally 2
• May cause gastric intolerance in some patients 2

Inflammatory Conditions

• For acute painful conditions: 75-150 mg daily in 3-4 divided doses 1
• Treatment duration typically 7-14 days 1
• For chronic inflammatory conditions: Start with 25 mg 2-3 times daily, with potential increase to 150-200 mg daily maximum 1

Administration Considerations

Formulations

• Available as 25 mg and 50 mg immediate-release capsules 1
• Sustained-release formulations (75 mg) may be used for once or twice daily dosing in certain conditions 3

Timing

• For persistent night pain/morning stiffness, administering a larger portion of the daily dose (up to 100 mg) at bedtime may provide better relief 1
• Take with food to minimize gastrointestinal side effects 2

Safety Considerations

Monitoring Requirements

• Baseline assessment: blood pressure, BUN, creatinine, liver function tests, CBC, and fecal occult blood 2, 4
• Follow-up monitoring every 3 months for long-term use 2

High-Risk Populations

• Use with caution in patients over 60 years of age 2, 4
• Use with caution in patients with history of peptic ulcer disease or significant alcohol use 2
• Use with caution in patients with cardiovascular disease or risk factors 2
• Use with caution in patients with renal or hepatic impairment 2

Common Adverse Effects

• Gastrointestinal effects: gastric upset, nausea, risk of peptic ulcer or GI bleeding 2
• Renal effects: may cause fluid retention or worsen renal function 2
• Cardiovascular effects: may cause or worsen hypertension 2

Management of Adverse Effects

• Discontinue if BUN or creatinine doubles or if hypertension develops/worsens 2
• Discontinue if liver function tests increase to three times the upper limit of normal 2
• Consider proton pump inhibitors for GI protection in high-risk patients 2

Special Considerations

• Use the lowest effective dose for the shortest duration consistent with treatment goals 1
• If adverse effects develop as dosage is increased, reduce dosage rapidly to a tolerated dose 1
• If severe adverse reactions occur, stop the medication 1
• For elderly patients, use with greater care due to increased possibility of adverse reactions 1
• Do not exceed 200 mg total daily dose 1