AlternativeIndocid
Indometacin
Non-selective NSAID (COX-1/2)
Tocolysis <32/40 when nifedipine unsuitable.
OralPR
First-line for
- Tocolysis <32/40 (short course)
- Polyhydramnios (↓ fetal urine output)
Mechanism
COX inhibition → ↓ PGE2/F2α → ↓ uterine contractility.
Indometacin — '32-48'
- 32 — only <32 weeks
- 48 — max 48 hours
Dosing
- Tocolysis
- 50 mg loading PO/PR, then 25 mg q6h ×48 h max
Contraindications
- AbsoluteGestation ≥32/40 (ductus closure)
- AbsoluteOligohydramnios, renal impairment, bleeding disorder
Side effects
- GI upset
- Maternal bleeding
- Oligohydramnios with prolonged use
Fetal & maternal notes
- • Premature ductus closure / pulmonary HTN if ≥32/40 or >48 h.
- • Necrotising enterocolitis ↑ in preterms.
Key interactions
Methotrexate
AvoidToxicity
Lithium
Caution↑ levels
Clinical pearls
- 💡 Useful when CCB contraindicated (e.g. cardiac).
- 💡 Daily AFI if course extended.
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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