Gouty arthritis, acute indomethacin

Indomethacin is available for the short-term treatment of acute gouty arthritis, acute pain of ankylosing spondylitis, and osteoarthritis. An injectable form to be reconstituted also is available as the sodium trihydrate salt for IV use in premature infants with patent ductus arteriosus. Because of its ability to suppress uterine activity by inhibiting prostaglandin biosynthesis, indomethacin also has an unlabeled use to prevent premature labor. 

Indomethacin (Indocin) is used in the treatment of acute gouty arthritis, rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. It is not recommended for use as a simple analgesic or antipyretic because of its potential for toxicity. While indomethacin inhibits both COX-1 and COX-2, it is moderately selective for COX-1. It produces more CNS side effects than most of the other NSAIDs. Severe headache occurs in 25 to 50% of patients vertigo, confusion, and psychological disturbances occur with some regularity. GI symptoms also are more frequent and severe than with most other... 

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. 

Indomethacin This NSAID is more potent than aspirin as an antiinflammatory agent, but it is inferior to the salicylates at doses tolerated by rheumatoid arthritic patients. In certain instances, however (for example, with acute gouty arthritis, ankylosing spondylitis, and osteoarthritis of the hip), indomethacin is more effective in relieving inflammation than is aspirin or any of the other NSAIDs. 

Indomethacin is as effective as colchicine in the treatment of acute gouty arthritis. Because acute gastrointestinal toxicity occurs far less frequently with indomethacin than with colchicine, it is preferred. Side effects imique to indomethacin include headache and dizziness. All NSAIDs have been implicated in the cause of gastric ulceration and bleeding, but with short-term therapy, this is not likely. 

Eor treatment of acute gouty arthritis, indomethacin may be begun with a relatively large dose for the first 24 to 48 hours and then tapered over 3 to 4 days to minimize the risk of recurrent attacks. Eor example, 75 mg of indomethacin should be given initially, followed by 50 mg every 6 hours for 2 days and then 50 mg every 8 hours for 1 or 2 days. 

Indomethacin, which has analgesic, antipyretic, and antiinflammatory actions, is indicated in moderate to severe rheumatoid arthritis (25 mg t.i.d.), in moderate to severe ankylosing spondylitis, in moderate to severe osteoarthritis, in bursitis or tendinitis (75 to 150 mg daily), and in acute gouty arthritis (50 mg t.i.d.) (see Figure 14 and Table 3). 

Recurrent attacks of gout can be prevented with the use of colchicine (e.g., 0.6 mg daily or on alternate days). Indomethacin (25 mg/day) also has been used. These agents are used early in the course of uricosuric therapy when mobilization of urate is associated with a temporary increase in the risk of acute gouty arthritis. 

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