Indications & Dose:
Pain and inflammation in rheumatic disease and other musculoskeletal disorders | Mild to moderate pain including dysmenorrhoea | Postoperative analgesia Migraine | Dental pain
Adult: Initially 300–400 mg 3–4 times a day; increased if necessary up to 600 mg 4 times a day; maintenance 200–400 mg 3 times a day, may be adequate
Adult: 1.6 g once daily, dose to be taken in the early evening, increased if necessary to 2.4 g daily in 2 divided doses, dose to be increased only in severe cases
Mild to moderate pain | Pain and inflammation of soft tissue injuries | Pyrexia with discomfort
Child 3–5 months: 50 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses; maximum 30 mg/kg per day
Child 6–11 months: 50 mg 3–4 times a day, maximum daily dose to be given in 3–4 divided doses; maximum 30 mg/kg per day
Child 1–3 years: 100 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses; maximum 30 mg/kg per day
Child 4–6 years: 150 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses; maximum 30 mg/kg per day
Child 7–9 years: 200 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses; maximum 30 mg/kg per day; maximum 2.4 g per day
Child 10–11 years: 300 mg 3 times a day, maximum daily dose to be given in 3–4 divided doses; maximum 30 mg/kg per day; maximum 2.4 g per day
Child 12–17 years: Initially 300–400 mg 3–4 times a day; increased if necessary up to 600 mg 4 times a day; maintenance 200–400 mg 3 times a day, may be adequate
Pain and inflammation
Child 12–17 years: 1.6 g once daily, dose preferably taken in the early evening, increased to 2.4 g daily in 2 divided doses, dose to be increased only in severe cases
Pain and inflammation in rheumatic disease including juvenile idiopathic arthritis
Child 3 months–17 years: 30–40 mg/kg daily in 3–4 divided doses; maximum 2.4 g per day
Pain and inflammation in systemic juvenile idiopathic arthritis
Child 3 months–17 years: Up to 60 mg/kg daily in 4–6 divided doses; maximum 2.4 g per day
Post-immunisation pyrexia in infants (on doctor’s advice only)
Child 2–3 months: 50 mg for 1 dose, followed by 50 mg after 6 hours if required
Pain relief in musculoskeletal conditions |
Treatment in knee or hand osteoarthritis (adjunct)
Contraindications:
Hypersensitivity to NSAIDs (including symptoms of asthma, nasal polyps, angioedema), Pregnancy.
Side Effects:
CNS: Anxiety, confusion, depression, dizziness, drowsiness, fatigue, insomnia, tremors
CI: CHF, dysrhythmias, hypertension, palpitations, peripheral edema, tachycardia
EENT: Blurred vision, hearing loss, tinnitus
GI: Anorexia, cholestatic hepatitis, constipation, cramps, diarrhea, dry mouth, flatulence, GI bleeding, jaundice, nausea, peptic ulcer, vomiting
GU: Azotemia, hematuria, nephrotoxicity, oliguria
HEME: Blood dyscrasias, increased bleeding time
SKIN: Pruritus, purpura, rash, sweating
Cautions:
Precautions:
History of Gl ulceration, bleeding, or perforation; renal dysfunction, hypertension or cardiac conditions aggravated by fluid retention and edema, history of liver dysfunction, history of coagulation
Interaction:
Drugs
Aminoglycosides: Reduced clearance with elevated aminoglycoside levels and potential for toxicity (especially indomethacin in premature infants; other NSAIDs probably)
Anticoagulants: Excessive by prothrombinemia, decreased platelet aggregation with increased risk of GI bleeding
Antihypertensives ( α -blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor bockers, ß-blockers, diuretics): Inhibition of antihypertensive and other favorable hemodynamic effects
Corticosteroids: Increased risk of GI ulceration
Cyclosporine: Increased nephrotoxicity risk
Lithium: Decreased clearance of lithium (mediated via prostaglandins) resulting in elevated serum lithium levels and risk of toxicity
Methotrexate: Decreased renal secretion of methotrexate resulting in elevated methotrexate levels and risk of toxicity
Phenylpropanolamine: Possible acute hypertensive reaction
Potassium-sparing diuretics:Additive hyperkalemia potential
Triamterene: Acute renal failure reported with addition of indomethacin; caution with other NSAIDs
Warnings:
Adverse Effects:
Lactations:
Reduces amniotic fluid volume, constriction of the ductus arteriosus in 3rd trimester; compatible with breast feeding
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
Patient And Carer Advice:
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