Diarrhea indomethacin

Sulindac (Clinoril) is chemically related to indomethacin and is generally used for the same indications. It is a prodrug that is metabolized to an active sul-hde metabolite and an inactive metabolite. The most frequently reported side effects are GI pain, nausea, diarrhea, and constipation. The incidence of these effects is lower than for indomethacin, presumably because sulindac is a prodrug and thus the active metabolite is not highly concentrated at the gastric mucosa. As with indomethacin, a rather high incidence of CNS side effects (dizziness, headache) also occurs. 

Although colchicine is more specific in gout than the NSAIDs, NSAIDs (eg, indomethacin and other NSAIDs [except aspirin]) have replaced it in the treatment of acute gout because of the troublesome diarrhea sometimes associated with colchicine therapy. Colchicine is now used for the prophylaxis of recurrent episodes of gouty arthritis, is effective in preventing attacks of acute Mediterranean fever, and may have a mild beneficial effect in sarcoid arthritis and in hepatic cirrhosis. Although it can be given intravenously, this route should be used cautiously because of increased bone marrow toxicity. 

Experimental and clinical observations indicate that non-steroidal anti-inflammatory agents (NSAIDs, see p. 403) such as aspirin and indomethacin are effective in controlling diarrhea. This antidiarrheal action is probably due to inhibition of prostaglandin synthesis. Bismuth subsalicylate (pepto-bismol), used for traveler s diarrhea, decreases fluid secretion in the bowel its action may be due to its salicylate component. 

Indomethacin and colchicine have equivalent efficacy in the treatment of acute gout. Colchicine is now more likely to be used chronically to prevent other attacks. Indomethacin is more—-not less— likely to precipitate sudden gastrointestinal bleeding and acute renal failure. In the dose used to treat acute gout, colchicine frequently causes significant diarrhea. The answer is (B). 

The abiiity of indomethacin to potentiy inhibit prostagiandin biosynthesis may account for its anti-inflammatory, antipyretic, and anaigetic actions. Pronounced side effects are frequently observed at antirheumatic doses. A large number of individuals taking indomethacin, especially those over the age of 70, experience undesirable effects of the Gl tract (e.g., nausea, dyspepsia, diarrhea, and erosion of the stomach walls), the CNS (e.g., headache, dizziness, and vertigo), and the ears (tinnitus), and many patients must discontinue its use. As with other arylalkanoic acids, administration of indomethacin with food or milk decreases Gl side effects. 

Whereas the toxicity of sulindac is lower than that observed for indomethacin and other NSAIDs, the spectrum of adverse reactions is very similar. The most frequent side effects reported are associated with irritation of the Gl tract (e.g., nausea, dyspepsia, and diarrhea), although these effects generally are mild. Effects on the CNS (e.g., dizziness and headache) are less common. Dermatological effects are less frequently encountered. 

Side effects were minimal in all patients in this study Seven experienced transient diarrhea during control periods This was attributed to colchicine and ceased when indomethacin was substituted ... 

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