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Indomethacin is a potent NSAID used for PDA closure, rheumatologic flares, and specific inflammatory conditions under specialist guidance.
NICU PDA regimens involve 0.2 mg/kg IV or oral dosing at 12–24 hour intervals; contraindicated when serum creatinine >1.7 mg/dL, platelets <50,000, or active GI bleeding.
For rheumatologic indications, initiate at 1–2 mg/kg/day divided 2–3 times daily with food and monitor CBC, CMP, and urinalysis every 3–6 months.
Indomethacin increases risk of GI ulceration—consider gastroprotective therapy (PPI) in high-risk children.
CNS adverse effects (headache, dizziness, mood changes) are dose-related; reduce or discontinue if neuro symptoms develop.
Avoid concomitant nephrotoxic agents (aminoglycosides, ACE inhibitors) and monitor blood pressure due to potential fluid retention.
Indomethacin is reserved for targeted inflammatory indications.
Primary indications include ductus arteriosus closure and specialist rheumatology cases.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Hemodynamically significant patent ductus arteriosus | Premature neonates | Yes | Administer IV indomethacin in the NICU with cardiorespiratory and renal monitoring to promote ductal closure when conservative therapy fails. |
| Juvenile idiopathic arthritis flare | Children | No | Consider when ibuprofen or naproxen are inadequate, with gastroprotection and periodic labs to detect toxicity early. |
| Serositis in rheumatologic disease (pericarditis, pleurisy) | Adolescents | No | Used under cardiology or rheumatology supervision when high-dose NSAID therapy is indicated for inflammatory serositis. |
| Bartter syndrome | Children | Yes | Chronic dosing reduces prostaglandin-mediated renal salt wasting; coordinate with nephrology for electrolyte and renal monitoring. |
FDA-approved primary uses with Level A evidence
Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Indomethacin has a higher side-effect burden than many NSAIDs; GI and CNS effects are common.
Serious adverse events include GI bleeding, renal impairment, and rare seizures in neonates.
Abdominal pain/nausea
Common • mild
GI bleeding
Uncommon • serious
Headache/dizziness
Common • mild
Seizures (neonates)
Rare • serious
Reduced urine output
Uncommon • serious
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Administration notes for pediatric indomethacin.
Administer with food or milk to minimize GI irritation. Shake the suspension thoroughly, measure with an oral syringe, and follow weight-based dosing precisely. Doses are typically divided every 8–12 hours in older children; PDA regimens follow NICU protocols.
Schedule gastrointestinal and renal monitoring (creatinine, CBC, liver enzymes) as directed. Avoid concurrent NSAIDs or aspirin unless prescribed, and ensure adequate hydration to reduce renal risk.
Emergency contact: Seek immediate medical care for vomiting blood, black or tarry stools, severe abdominal pain, shortness of breath, chest pain, or decreased urine output.
Use only for the prescribed duration, keep follow-up appointments, and report new neurologic symptoms (headache, dizziness, visual changes) promptly.
Different formulations and concentrations
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By lowering prostaglandin E2 levels, indomethacin decreases inflammation and facilitates closure of the ductus arteriosus in premature infants.
Indomethacin blocks COX-mediated prostaglandin production, leading to intense anti-inflammatory activity.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Clinical pearls to support safe indomethacin use.
Highlight monitoring and stewardship.
Reserve for clearly defined indications due to high adverse-effect burden.
Check renal function, liver enzymes, and CBC when therapy exceeds several days.
Consider proton pump inhibitor when prolonged use is unavoidable.
Core insights every provider should know
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Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Indomethacin and monitor your child's response to treatment.
Indomethacin provides stronger anti-inflammatory effects and is used when other NSAIDs fail or for specific conditions like ductus arteriosus closure.
Yes, taking it with food or milk is important to protect the stomach.
Dizziness or headache can occur. Encourage rest and report severe or persistent symptoms.
Courses are kept as short as possible. Follow your clinician’s taper schedule if prescribed.