Pharmacokinetics of indomethacin in pregnancy.
OBJECTIVE
Although indomethacin has been widely used for the treatment of preterm labor over the past 40 years, there are few reports regarding its pharmacokinetics in pregnant women.


METHODS
This opportunistic study assessed the steady-state pharmacokinetics of indomethacin in pregnant subjects to whom an oral dose of 25 mg every 6 h was prescribed. Indomethacin concentrations in plasma and urine were analyzed by a validated high-performance liquid chromatography method with mass spectrometric detection.


RESULTS
The mean area under the plasma concentration versus time curve at steady state (AUCss) was 1.91 ± 0.53 μg·h/mL, mean peak plasma concentration (C max) was 1.02 ± 0.49 μg/mL, and mean time to reach C max (t max) was 1.3 ± 0.7 h. The mean apparent clearance at steady state was 14.5 ± 5.5 L/h, which is higher than the apparent clearance reported in the literature for non-pregnant subjects. Indomethacin crosses the placenta; the mean fetal/maternal ratio from five sets of cord blood samples collected at delivery was 4.0 ± 1.1.


CONCLUSIONS
Further studies are needed to determine whether any dose adjustments are necessary as a result of the increased clearance of indomethacin during pregnancy.
Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0587, USA, erik.rytting@utmb.edu.
Erik
E
Rytting
Tatiana N
TN
Nanovskaya
Xiaoming
X
Wang
Daria I
DI
Vernikovskaya
Shannon M
SM
Clark
Marlo
M
Cochran
Susan M
SM
Abdel-Rahman
Raman
R
Venkataramanan
Steve N
SN
Caritis
Gary D V
GD
Hankins
Mahmoud S
MS
Ahmed
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D013058:Mass Spectrometry / Q000379:methods; D008431:Maternal-Fetal Exchange; D010920:Placenta / Q000378:metabolism*; D011247:Pregnancy; D015149:Tocolytic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D055815:Young Adult
D015149:Tocolytic Agents; D007213:Indomethacin