Indomethacin in pregnancy and its possible effects

Indomethacin belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs) of non-selective action.

This drug is produced under almost four dozen trade names: Indocid, Indopal, Inteban, Articin, Dolopas, Matartril, etc.

The main question that many pregnant women ask is: can Indomethacin be used during pregnancy?

Doctors know the answer to this: the use of Indomethacin during pregnancy is contraindicated, which is actually indicated in the instructions for the drug.

Read the instructions for the medications you are prescribed so as not to harm your health or endanger your unborn child.

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Indications Indomethacin in pregnancy

In addition to the anti-inflammatory effect, NSAIDs are excellent at dealing with pain of any etiology and localization, elevated temperature and edema. And indications for the use of Indomethacin include headache and toothache; otitis, pharyngitis and tonsillitis; arthritis, arthrosis, gout, myositis and neuralgia.

Like other non-steroidal anti-inflammatory drugs, this drug is taken for painful menstruation, inflammation of the bladder and kidneys, uterus, appendages, prostate gland, as well as thrombophlebitis and varicose veins.

However, in obstetric practice, Indomethacin is sometimes prescribed for tone during pregnancy, that is, for hypertonicity of the uterus, which in some pregnant women is accompanied by nagging pain. But Indomethacin does not affect the cause of this condition, and with constantly increased tension of the muscular walls of the uterus, according to the treatment regimen, antispasmodics, magnesium and pyridoxine (vitamin B6) are usually used, as well as various relaxation techniques.

There are also options where obstetricians prescribe antibacterial and diuretic drugs, as well as Indomethacin for polyhydramnios of pregnancy - if an excess of the physiological norm of amniotic (fetal) fluid is detected.

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Release form

Indomethacin is available in the form of tablets and capsules (25 mg); rectal suppositories (suppositories of 0.05 and 0.1 g); injection solution (in ampoules of 1 ml); 10% ointment (in tubes of 40 g).

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Pharmacodynamics

The versatile therapeutic action of Indomethacin, which is related to the derivatives of indoacetic acid, is provided by the inactivation of the enzyme cyclooxygenase (COX1 and 2), as a result of which certain changes occur in the metabolism of unsaturated fatty arachidonic (cis-5,8,11,14-eicosatetraenoic) acid. In turn, the formation of prostaglandins (nociceptive system mediators), prostaglandins E-1 (pyrogenic mediators) and thromboxanes (ensuring the process of platelet aggregation), which are produced during the exchange of arachidonic acid, ceases or significantly decreases.

By suppressing inflammatory reaction factors, pain stops and inflammation and swelling go away.

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Pharmacokinetics

Indomethacin is well absorbed in all forms. The bioavailability of the drug taken orally in tablet form is 98%, in the form of rectal suppositories - 90%, in the form of ointment - about 80%. Almost 90% of the active substance binds to serum proteins, reaching maximum concentration after 60-100 minutes.

Indomethacin crosses the blood-brain barrier and penetrates the placenta, entering breast milk.

Biotransformation of the drug occurs in the liver, and elimination from the body (partially unchanged) occurs with urine and feces.

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Dosing and administration

The standard single dose of Indomethacia tablets is 25 mg, the number of doses during the day is no more than three. The maximum permissible daily dose is 100-125 mg.

The suppositories are used rectally - one twice a day (the second time before bedtime).

Overdose of this drug leads to an increase in its side effects and the development of acidosis, convulsions and fainting.

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Contraindications

The list of contraindications for Indomethacin includes:

• gastric ulcer and duodenal ulcer;
• enterocolitis;
• bronchial asthma;
• congenital heart defect and chronic heart failure;
• arterial hypertension;
• severe functional insufficiency of the liver and kidneys;
• low platelet count in the blood;
• mental disorders and mental illnesses;
• age under 14 years.

Indomethacin is contraindicated during pregnancy (read below to find out why).

In addition, rectal suppositories are not used for hemorrhoids and proctitis.

Why is Indomethacin contraindicated during pregnancy?

Research on NSAIDs, which may be recommended to pregnant women by insufficiently qualified doctors, has been conducted for many years. And their results confirm the risk of negative effects of drugs of this pharmacological group.

Possible consequences for the fetus of any form of Indomethacin, including the consequences for the child of Indomethacin suppositories during pregnancy are manifested by a decrease in the volume of amniotic fluid (leading to congenital anomalies), disruption of the acid-base balance of the body (acidosis), and renal failure.

Indomethacin should not be used in early pregnancy due to the increased risk of intrauterine growth retardation and the development of hypoplastic left ventricle syndrome. This may be due to a deficiency of phospholipids, which are necessary for the formation of cellular and cytoplasmic membranes of organ-forming tissues of the embryo and fetus.

Indomethacin and most NSAIDs are also contraindicated in later stages of pregnancy. And the reasons for this are very serious. First, the ductus arteriosus, the arterial duct that connects the pulmonary artery blood vessel coming from the right ventricle of the heart and the dorsal aorta, may close too early. Premature closure of this duct results in the development of a congenital heart defect. The fetus may also have increased pulmonary blood flow with persistent pulmonary hypertension of the newborn.

As studies have shown, in the last trimester of pregnancy, closer to the time of delivery, the activity of specific enzymes of placental tissues for the breakdown of phospholipids increases significantly, which is explained by the beginning of the process of preparation for childbirth. The fact is that for their initiation, a sufficiently high level of prostaglandins is necessary (which were discussed in the description of the pharmacodynamics of Indomethacin), and the source for their synthesis is free fatty arachidonic acid.

Thus, if you use Indomethacin suppositories in the 3rd trimester of pregnancy, the fetoplacental system will receive less arachidonic acid, and this can cause weakness of labor and various complications of childbirth.

Also, due to the disruption of arachidonic acid metabolism and its deficiency, the secretion of thromboxanes, which ensure normal blood clotting, decreases. That is why the use of any NSAIDs in the late stages of gestation can lead to the birth of infants with platelet disorders and hemorrhagic syndrome.

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Side effects Indomethacin in pregnancy

In addition to an allergic reaction, including anaphylaxis, Indomethacin can cause side effects that manifest themselves as:

• nausea, vomiting, abdominal pain, intestinal problems;
• increased activity of liver enzymes and bilirubin levels;
• tachycardia and arrhythmia, increased blood pressure;
• headache, increased fatigue, sleep disturbances, depressive state;
• deterioration of vision (with clouding of the cornea) and hearing, taste disturbances;
• impaired kidney function (with damage to the nephrons and renal papillae) and a decrease in the volume of urine excreted;
• an increase in glucose levels in the blood and urine, and an increase in potassium ions in the blood plasma.

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Interactions with other drugs

The combination of Indomethacin with drugs of the corticosteroid group may lead to gastric bleeding.

NSAIDs, including Indomethacin, potentiate the action of insulin and indirect anticoagulants. In addition, Indomethacin reduces the hypotensive effect of beta-blockers (used for high blood pressure), as well as the diuretic effect of loop diuretics and the contraceptive effect of hormonal contraceptive pills.

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Reviews

A difficult question: should a future mother trust the doctor monitoring the course of her pregnancy, or should she treat all prescriptions with caution? At the same time, no reviews of this or that drug on various women's Internet forums for pregnant women will help solve their health problems...

Only reliable information about medications that may be prescribed during pregnancy will help protect against possible negative consequences.