From the Guidelines
Treatment of Acute Gouty Arthritis
Naproxen is considered a better option than indomethacin for the treatment of acute gouty arthritis due to its more favorable gastrointestinal side effect profile and similar efficacy to indomethacin 1.
Dosage and Administration
- Indomethacin is typically administered at a dose of 50mg orally every 8 hours, with a maximum daily dose of 150-200mg, for a duration of 3-5 days.
- Naproxen, on the other hand, is usually given at a dose of 500-750mg orally twice daily, with a maximum daily dose of 1250mg, for a duration of 3-5 days.
Efficacy and Safety
Both medications are effective in treating acute gouty arthritis, but naproxen has a more favorable gastrointestinal side effect profile compared to indomethacin 1. Additionally, there is no evidence that indomethacin is more efficacious than other NSAIDs, such as naproxen and ibuprofen 1.
Key Considerations
- Patients with renal disease, heart failure, or cirrhosis may need to avoid NSAIDs, including indomethacin and naproxen 1.
- Colchicine is also an effective option for treating acute gouty arthritis, but it is more expensive than NSAIDs or corticosteroids and has a different side effect profile 1.
From the FDA Drug Label
In clinical studies in patients with rheumatoid arthritis, osteoarthritis, and juvenile arthritis, naproxen has been shown to be comparable to aspirin and indomethacin in controlling the aforementioned measures of disease activity In patients with acute gout, a favorable response to naproxen was shown by significant clearing of inflammatory changes (e.g., decrease in swelling, heat) within 24 to 48 hours, as well as by relief of pain and tenderness. Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis
- Efficacy Comparison: Both naproxen 2 and indomethacin 3 have been shown to be effective in treating acute gouty arthritis.
- Key Findings: Naproxen has been found to be comparable to indomethacin in controlling disease activity in various studies, but direct comparison of efficacy in acute gouty arthritis is not explicitly stated.
- Conclusion: The available information does not allow for a direct comparison of the efficacy of naproxen and indomethacin in the treatment of acute gouty arthritis, as the studies provided do not include a head-to-head comparison of the two drugs for this specific condition.
From the Research
Comparison of Indomethacin and Naproxen for Acute Gouty Arthritis
- The effectiveness of naproxen in managing acute gouty arthritis was assessed in a study published in 1975 4, which found that naproxen was effective in alleviating the inflammation of acute gout.
- A review of naproxen's pharmacological properties and therapeutic efficacy published in 1979 5 noted that naproxen was as effective as aspirin but better tolerated, and that it was a suitable alternative to indomethacin in certain cases.
- However, there is limited direct comparison between indomethacin and naproxen in the treatment of acute gouty arthritis.
- A study published in 2007 6 compared the effectiveness of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in treating acute goutlike arthritis, and found that prednisolone was as effective as indomethacin in relieving pain but was associated with fewer adverse effects.
- Another study published in 1988 7 compared the effectiveness of parenteral adrenocorticotropic hormone with oral indomethacin in treating acute gout, and found that adrenocorticotropic hormone was more effective and had fewer side effects than indomethacin.
- A study published in 2002 8 compared the safety and efficacy of etoricoxib and indometacin in treating acute gouty arthritis, and found that etoricoxib was comparable to indometacin in terms of efficacy but had a better safety profile.
Efficacy and Safety
- Naproxen has been shown to be effective in alleviating the inflammation of acute gout 4, 5.
- Indomethacin has been compared to other treatments, including prednisolone 6 and adrenocorticotropic hormone 7, with varying results.
- Etoricoxib, a selective cyclo-oxygenase-2 inhibitor, has been shown to be comparable to indometacin in terms of efficacy but with a better safety profile 8.
- The choice between indomethacin and naproxen may depend on individual patient factors, such as tolerance and response to treatment, as well as the presence of any comorbidities or contraindications.