Heterocyclic Acetic Acids
Frontal headache is the most common adverse effect following therapeutic dosing with these compounds. Other reported effects include gastritis, epigastric distress, lightheaded-ness, vertigo, dizziness, mental confusion, and occasionally
somnolence, stupor, or hallucinations. Neutropenia, thrombo-cytopenia, and rarely aplastic anaemia may occur following chronic ingestion of therapeutic doses.
Intoxication with indomethacin is generally not associated with serious effects, though occasionally it may cause convul-sions. Nausea, vomiting, gastritis, gastrointestinal ulceration with perforation, and haemorrhage may occur. Disorientation, mental confusion, and lethargy have been reported. Sulindac overdose can cause renal failure. It has also been implicated in development of psychosis, especially in the elderly patient. Ketorolac has been withdrawn from use in some countries and restrictions imposed in other countries because of its severe adverse effects relating to GI tract and kidneys, while zomepirac has been withdrawn in the USA because of its tendeny to induce anaphylaxis.
Treatment of overdosage is symptomatic and supportive. Patients should be monitored for possible gastrointestinal ulceration and/or haemorrhage. Monitor renal function and haematocrit in symptomatic patients. Antacids may be of some value for relief of symptoms in patients with gastrointestinal symptoms.