What are the guidelines for taking Indomethacin (Nonsteroidal Anti-Inflammatory Drug) 75mg twice a day (bid)?

Indomethacin 75mg BID Dosing Guidelines

The recommended dosage of indomethacin 75mg twice daily (BID) is appropriate for moderate to severe inflammatory conditions, but should be used at the lowest effective dose for the shortest duration possible to minimize adverse effects. 1

Approved Indications and Dosing

• Indomethacin 75mg BID falls within the FDA-approved dosing range for moderate to severe rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis (total daily dose of 150mg) 1
• For acute gouty arthritis, the recommended dosage is 50mg three times daily until pain is tolerable, then rapidly reduce to complete cessation 2, 1
• For acute painful shoulder (bursitis/tendinitis), dosing of 75-150mg daily in 3-4 divided doses is recommended, with treatment typically lasting 7-14 days 1

Administration Guidelines

• Taking indomethacin with food helps minimize gastrointestinal side effects 2
• The total daily dose should not exceed 200mg 1
• For patients with persistent night pain or morning stiffness, administering up to 100mg of the daily dose at bedtime may provide better relief 1

Safety Considerations and Monitoring

• Baseline assessment should include blood pressure, BUN, creatinine, liver function tests, CBC, and fecal occult blood, with follow-up monitoring every 3 months for long-term use 2
• If minor adverse effects develop during dose increases, rapidly reduce to a tolerated dose and observe the patient closely 1
• If severe adverse reactions occur, discontinue the medication immediately 1
• Consider gastroprotection with a proton pump inhibitor in high-risk patients 2

Special Populations

• Use with greater caution in elderly patients due to increased risk of adverse reactions 1
• Use with caution in patients with history of peptic ulcer disease, cardiovascular disease, renal or hepatic impairment 2
• Indomethacin ordinarily should not be prescribed for pediatric patients 14 years of age and under 1

Common Adverse Effects

• Gastrointestinal effects: gastric upset, nausea, risk of peptic ulcer or GI bleeding 2
• Renal effects: fluid retention, worsened renal function 2
• Cardiovascular effects: hypertension 2
• Neurological effects: headache, dizziness 3

Duration of Treatment

• For chronic conditions like rheumatoid arthritis, after achieving control of symptoms, attempt to reduce the daily dose repeatedly until the patient is receiving the smallest effective dose 1
• For acute conditions like gout, discontinue after pain is controlled 2, 1
• Long-term use (years) at 75-100mg daily has been shown to be effective and generally well-tolerated in selected patients who don't experience initial side effects 3

Pharmacokinetics

• Indomethacin has a biological half-life of about 5-10 hours 4
• Following oral administration, absorption is rapid and complete, with peak plasma concentrations achieved within 1-2 hours 4
• Approximately 90% of indomethacin is bound to plasma proteins 4
• About 60% of an oral dose is excreted in urine and 40% in feces after biliary secretion 4

Drug Interactions

• Probenecid can increase plasma concentrations of indomethacin 4
• Avoid combining with other NSAIDs as this increases risk of adverse effects without providing additional benefit 5