Dialyzability and Pharmacokinetics of Indomethacin in Adult Patients with End-Stage Renal Disease

Abstract

Indomethacin, a nonsteroidal antiinflammatory drug, has been shown to be effective for the treatment of pericarditis in chronic hemodialysis patients. Data regarding the dialyzability of indomethacin in these patients, however, is lacking. The aim of this study, therefore, was to evaluate (1) the dialyzability, and (2) the absorption and elimination kinetics of indomethacin, using six stable anephric adult patients who were maintained on chronic hemodialysis and were receiving indomethacin for the management of their uremic pericarditis. The results from this study demonstrate that indomethacin is dialyzable, but not to an appreciable extent. The mean predialysis and postdialysis indomethacin plasma levels were 3.4 and 1.6 micrograms/ml, respectively. The mean total amount of indomethacin removed by five hours of hemodialysis was 19.6 percent of the single dose of indomethacin 100 mg po. However, mean Cpmax, tmax, t1/2, and AUC0-infinity during and in the absence of hemodialysis were 5.4 and 5.4 micrograms/ml (not statistically significant [NS]), 1.9 and 2.0 h (NS), 6.1 and 5.3 h (NS), and 30.9 and 35.7 micrograms h ml-1 (NS), respectively. Based on these findings, it can be concluded that although indomethacin is dialyzable, no dosage adjustment is required in patients receiving indomethacin for the management of their uremic pericarditis when undergoing maintenance hemodialysis.

Pain in Chronic Kidney Disease: A Scoping Review

“…Studies of other acetic acid derivatives, etodolac, bromfenac and indomethacin, in CKD and ESRD patients, do not suggest that any dose adjustment is necessary .…”

“…These studies suggest that in ESRD, a higher dose of sulindac may be required for analgesic effect. Studies of other acetic acid derivatives, etodolac, bromfenac and indomethacin, in CKD and ESRD patients, do not suggest that any dose adjustment is necessary (167)(168)(169). Propionic acid derivatives (the -profens): 11 studies identified CKD Studies evaluating ketoprofen, ximoprofen and benoxaprofen have shown increased half-life in CKD (170)(171)(172)(173).…”