Indomethacin interaction

In general, interactions are similar to those of NSAIDs. Indomethacin interacts with probenecid and aminoglycoside antibiotics. Concomitant administration of indomethacin and diflunisal should be avoided because of fatal GI complications. Similarly, concurrent administration of indomethacin and haloperidol produces severe drowsiness and confusion. 

Finch MB, Kelly JG, Johnston GD, McDevitt DG. Evidence against a digoxin-indomethacin interaction. Br J Clin Pharmacol 1983 16 P212-13. 

Mayes LC, BoerthRC, Digoxin-indomethacin interaction. PediatrRes (19S0 ) 14,469. 

Ylitalo, P., Pitkajarvi, T., Pyykonen, M.L., Nurmi, A.K., Sappala, E. and Vapaatalo, H. (1985). Inhibition of prostaglandin synthesis by indomethacin interacts with the antihypertensive effect of atenolol. Clin. Pharmacol Ther., 38, 443-449... 

Del Soldato, P., Foschi, D., Benoni, G. and Scarpignato, C. (1985). Oxygen free radicals interact with indomethacin to cause gastrointestinal injury. Agents Actions 17, 484-488. 

The interaction between drug compounds and excipients, as these influence drug dissolution, can be successfully studied by means of reflectance spectroscopy. In one study concerning probucol and indomethacin, it was deduced that hydrogen bonding and van der Waals forces determined the physisorption between the active and the excipients in several model formulations [36]. Chemisorption forces were found to play only minor roles in these interactions. These studies indicated that surface catalytic effects could be important during the selection of formulation excipients. 

Drugs that may interact with alendronate include ranitidine and aspirin. Drugs that may interact with tiludronate include aspirin and indomethacin. Calcium... 

Drugs that interact may include beta blockers, indomethacin, verapamil, and clonidine. 

Drugs that may interact with hydralazine include beta blockers (eg, metoprolol, propranolol) and indomethacin. 

Drugs that may interact with losartan include cimetidine, phenobarbital, fluconazole, indomethacin, and rifamycins. 

Drug interactions with diflusinol include acetaminophen anticoagulants, oral hydrochlorothiazide indomethacin sulindac. 

Hydralazine (Apresoline/ Others) [Antihypertensive/ Vasodilator] Uses Mod-severe HTN CHF (w/ Isordil) Action Peripheral vasodilator Dose Adults. Initial 10 mg PO qid, T to 25 mg qid 300 mg/d max Peds. 0.75-3 mg/kg/24 h POq6—12h -i in renal impair V CBC ANA before Caution [C, +] -1- Hqjatic Fxn CAD T tox w/ MAOI, indomethacin, BBs Contra Dissecting aortic aneurysm, mitral valveAheumatic heart Dz Disp Tabs, inj SE SLE-like synd w/ chronic high doses SVT following IM route, p ipheral neuropathy Interactions T Effects W/ antih5 pertensives, diazoxide, diuretics, MAOIs, nitrates. 

Muromonab-CD3 (Orthoclone OKT3) [Immunosuppressant/ Monoclonal Antibody] WARNING Can cause anaphylaxis monitor fluid status Uses Acute rejection following organ transplantation Action Murine Ab, blocks T-cell Fxn Dose Per protocol Adults. 5 mg/d IV for 10-14 d Peds. 0.1 mg/kg/d IV for 10-14 d Caution [C, /-] w/ Hx Szs, PRG, uncontrolled HTN Contra Murine sensitivity, fluid overload Disp Inj SE Anaphylaxis, pulm edema, fever/chills w/ 1st dose (premedicate w/ stCToid/APAP/antihistamine) Interactions t Effects W/ immunosuppressives t effects OF live virus vaccines t risk of CNS effects encephalopathy W/ indomethacin EMS Monitor for S/Sxs of Infxn monitor resp Fxn, known to... 

Uses Infxns of resp tract, skin/soft tissue, scarlet fevCT, S5 philis Action Bactericidal -1- cell wall synth Dose Adults. 0.6-4.8 million Units/d in doses ql2-24h give probenecid at least 30 min prior to PCN to prolong action Feds. 25,000-50,000 Units/kg/d IM daily-bid Caution [B, M] Contra AU gy Disp Inj SE Pain at inj site, int stitial n hritis, anaphylaxis Interactions t Effects W/probenecid t penicillin 1/2-life Wf ASA, furosemide, indomethacin, sulfonamides, thiazide diuretics T risk of bleeding W/ anticoagulants -1- effects Wf chloramphenicol, macrolides, tetracyclines -1- effects OF OCPs EMS See Penicillin G, Aqueous OD See Penicillin G, Aqueous... 

III.a.4.3. Changes in renal blood flow. Blood flow through the kidney is partially controlled by the production of renal vasodilatory prostaglandins. If the synthesis of these prostaglandins is inhibited (e.g. by indomethacin), the renal excretion of lithium is reduced with a subsequent rise in serum levels. The mechanism underlying this interaction is not entirely clear, as serum lithium levels are unaffected by some potent prostaglandin synthetase inhibitors (e.g. aspirin). If an NSAID is prescribed for a patient taking lithium the serum levels should be closely monitored. 

Lithium intoxication can be precipitated by the use of diuretics, particularly thiazides and metola-zone, and ACE inhibitors. NSAIDs can also precipitate lithium toxicity, mainly due to NSAID inhibition of prostaglandin-dependent renal excretion mechanisms. NSAIDs also impair renal function and cause sodium and water retention, effects which can predispose to interactions. Many case reports describe the antagonistic effects of NSAIDs on diuretics and antihypertensive drugs. The combination of triamterene and indomethacin appears particularly hazardous as it may result in acute renal failure. NSAIDs may also interfere with the beneficial effects of diuretics and ACE inhibitors in heart failure. It is not unusual to see patients whose heart failure has deteriorated in spite of increased doses of frusemide who are also concurrently taking an NSAID. 

Many interactions with lithium have been described. Thiazide and loop diuretics decrease lithium excretion predisposing to serious lithium toxicity. Also non-steroidal anti-inflammatory agents, especially indomethacin can increase the risks for lithium toxicity due to decreased renal excretion. 

Ragheb M, Ban TA, Buchanan D, et al. Interaction of indomethacin and ibuprofen with lithium in manic patients under a steady-state lithium level. J Clin Psychiatry 1980 41 397-398. 

Nonsteroidal anti-inflammatory drugs [P] Indomethacin reduces antihypertensive response other prostaglandin inhibitors probably also interact. 

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