NSAIDs include- Propionic acid- Fenoprofen, Flurbiprofen, Ibiprofen, Ketoprofen, Naproxen, Naproxen Sodium, Oxaprozin Acetic acids- Diclofenac sodium, Etodolac, Indomethicin, Ketorolac, Nabumetone, Sulindac, Tolmetin Fenamates (anthralic acids) - Meclofenamate, Mefenamic acxid Oxicams- Piroxicam

Refer- Ibuprofen

Interacting drugs - summary

 Indomethicin +

Indomethicin IV +Aminoglycosides                                                                                           In preterm infants, the use of indomethicin for closure of patent  ductus arteriosus resulted in aminoglycosides accumulation in one study

Moderate to severe rheumatoid arthritis,, Ankylosing spondylysis, osteoarthritis.

NSAIDs include- Propionic acid- Fenoprofen, Flurbiprofen, Ibiprofen, Ketoprofen, Naproxen, Naproxen Sodium, Oxaprozin Acetic acids- Diclofenac sodium, Etodolac, Indomethicin, Ketorolac, Nabumetone, Sulindac, Tolmetin Fenamates (anthralic acids) - Meclofenamate, Mefenamic acxid Oxicams- Piroxicam

Refer- Ibuprofen

G.I.T.haemorrhage, hyperkalemia, marrow supression.

Stevens-Johnson syndrome rarely hepatitis. G.I.T.upsets, headache, dizziness, tinnitus, somnolence, fatigue and confusion, hyperglycaemia, raised liver enzymes.

Active peptic ulcer,pregnancy,lactation.Hypersensitivity to aspirin and other NSAIDs.

Warnings

Do not give indomethicin or sulindac to patients with active GI lesions or a history of recurrent GI lesions, unless the very high risk is warranted risk is warranted and patients can be monitored very closely

CNS effects- indomethicin may aggravate depression or other psychiatric disturbances, epilepsy, and parkinsonism, use with considerable caution. Some of these agents may cause headache ( highest incidence with fenoprofen, indomethicin, and ketorolac ). If headache pesists despite dosage reduction, discontinue use Special precautions: Recurrent indigestion,hypertension,CCF,small children.

Indications:

Moderate to severe rheumatoid arthritis,, Ankylosing spondylysis, osteoarthritis.

Dosage:

25 mg 2 or 3 times a day.

EVIDENCE BASED MEDICINE (April 2003)

Premenstrual sydrome

Comparative effectiveness of various intreventions

Beneficial

Overall Premenstrual Syndrome

Symptoms

1. Prostagalndin inhibitors (e.g. Indomethicin)

2. Selective serotonin Reuptake Inhibitors (e.g. Fluoxetine, Seratinine, Fluvoxamine)

Breast symptoms only

1. Leuteal phase control

2. Bromocriptine

Bloatedness and Swelling

1. Spironolactone/ diuretics

Likely to be beneficial

1. Tobolone

2. Oestrogen

3. Vitamin B-6

4. Evening primrose B-6 Trade-off between

Benefits and Harms

1. Danazol

2. Gonodotropin-releasing hormone (GnRH analogues)

3. Non-SSRI antidepressants/ anxiolytics

4. Hysterectomy with/without oophorectomy

Unknown effectiveness

1. Progesterone

2. Progestogens

3. Oral contraceotives

4. Cognitive behaviour treatment

5. Dietary supplements

6. Relaxation treatment

7. Endometrial ablation

8. Laproscipic bilateral oophorectomy

KEY POINTS

1. Trials have found that SSRIs and prostagalndin inhibitors relieve premenstrual symptoms. Antidepressants and ovulation suppression with danazol and GnRH analoges are also effective but have significant adverse effects, including the masculanising effects of danazol and the menopausal effects of GnHR analogues.

2. There is a limited evidence suggesting that oestrogen, viatmin-B6 , evening Primrose Oil and excercise may also be beneficoial

3. Trials have found that bromocriptine is effective for breast symptoms and diuretics are effective for bloatedness and swelling. Both can have adverse efects.

4. There is no good evidence to support the use of progesterone or oral contraceptives

5. Few treatments have been adequately validated in trials.

Agranulocytosis- ( Schultz syndrome ) ( 287 )

 Severe neutropenia occurs as an occassional or rare reaction to a great variety of drugs . In most instances the patient is seen by the physician seeveral weeks or months after beginning the ofending agent and presents acutely ill with fever, sore throat, and oral and perreinal ulceration. The total leukocyte count is ofeten 1000 to 2000 per cubic millimeter, and the neutrophils are absent from the bone marrow.

Drugs causing adverse reactions- ( 385 )

1. Chloramphenicol

2. Sulphonamides

3. Phenylbutazone

4. Gold salts

5. Indomethicin

6. Propylthiouracil

7. Methimazole

8. Carbimazole

9. Phenothiazines

10. Cytotoxics

11 Tolbutamide

12. Cotrimoxazole

13. Tricyclic antidepressants

Name: Indomethicin

Classification: Analgesics/anti-inflammatory.

Patent position: Major brands INDICIN IDPL INDOCAP JAGSON PAL

Raw materials:

1.Methoxy phenyl hydrazine

2.Chlorobenzoyl chloride

3.Acetyl nitro propane

4.Diacetylethane

5.Methoxy nitrotoluene

6.Bromoethyl acetate

7.Chlorobenzyl methoxy phenyl hydrazine **

8.Levullinic acid ** ** concessional duty

1. NSAIDs can cause discomfort and rarely more serious side effects such as GI bleeding which may result in hospitalisation and even fatalities.

2.Avoid aspirin and alcoholic beverages while taking medication.

3. If GI upset occurs, take with food, milk or antacids. For GI upset with tolmetin, use antacids other than sodium bicarbonate.

4. Notify physician, if skin rash, itching, visual disturbances, weight gain, edema occurs

5. Mefanamic acid and metclofenate: if rash, diarrhoea, or digestive problem occur discontinue use and consult physician

6. Ibuprofen- Do not take for more than 3 days for fever or 10 days for pain. If these symptoms persists,consult a physican.

Refer NSAIDs - Ibuprofen

Absorption delayed

Children- 

Effectiveness in children below 14 years has not been established.