acemetacin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
acemetacin: clinical details
Prescribing considerations
- Assess gastrointestinal, cardiovascular, renal, hepatic and bleeding risks before prescribing.
- Older people have greater risk of serious gastrointestinal adverse effects.
- Consider gastroprotection where gastrointestinal risk is increased.
- Use cautiously in asthma, hypertension, heart failure, inflammatory bowel disease, systemic lupus erythematosus, mixed connective-tissue disease, epilepsy, Parkinson's disease, psychiatric illness and varicella-zoster infection.
- Acemetacin may mask signs of infection and impair female fertility.
Contraindications and cautions
- Hypersensitivity to acemetacin, indomethacin or an excipient
- Previous asthma, rhinitis, angioedema or urticaria triggered by aspirin or another NSAID
- Active or recurrent peptic ulceration or haemorrhage
- Previous NSAID-related gastrointestinal bleeding or perforation
- Severe heart, liver or kidney failure
- Unexplained blood-formation disorder
- Nasal polyps associated with angioedema
- Pregnancy after 28 weeks
- Children and adolescents
Monitoring
- Renal function in at-risk patients and periodically during continuing treatment
- Liver function during continuing treatment
- Full blood count and coagulation where treatment continues or bleeding risk is increased
- Blood pressure, oedema and signs of heart failure
- Gastrointestinal symptoms or occult bleeding, especially in older people
- Potassium when combined with potassium-sparing diuretics
- Periodic ophthalmological assessment in chronic rheumatoid disease
Clinical pharmacology
Acemetacin is a glycolic-acid ester of indomethacin. Both the parent compound and indomethacin contribute to activity; oral absorption is good, elimination is hepatic and renal, and the drug is highly protein-bound.
Formulation and product differences
- The selected UK product is an oral gelatin capsule.
- It contains lactose and is unsuitable for people with specified rare hereditary disorders of galactose or lactose handling.
- The capsule shell contains ferric oxides and titanium dioxide.
acemetacin interactions
Check all prescribed, pharmacy and herbal products with a pharmacist or prescriber. Important interactions include:
Other NSAIDs, including ibuprofen, naproxen, aspirin and COX-2 inhibitors
Combining NSAIDs increases gastrointestinal bleeding and other adverse-effect risks.
Warfarin and other anticoagulants
Acemetacin may increase anticoagulant effects and bleeding risk, requiring clinical and clotting assessment.
Antiplatelets, corticosteroids and SSRIs
These combinations can further increase gastrointestinal ulceration or bleeding risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.