Time-dependent inhibition of platelet cyclooxygenase by indomethacin is slowly reversible.

Indomethacin has been characterized in vitro as a time-dependent, irreversible inhibitor of cyclo-oxygenase, yet its effects on human platelets have been found to be reversible in vivo. To understand this apparent contradiction, we have investigated the kinetics of recovery of platelet thromboxane production after a single dose of indomethacin. The inhibition of platelet thromboxane production was greater than would be expected from the levels of indomethacin found in the plasma suggesting that the time-dependent inhibition occurs in vivo. Yet recovery of platelet thromboxane production was faster than expected for an irreversible inhibitor, with 50% of control values being regained within 24 hours after ingestion of the drug. When platelets were isolated and resuspended in homologous drug-free plasma, slow recovery of thromboxane production was seen to occur with 50% of control activity regained in 100 minutes. This recovery was much slower than that seen from a competitive inhibitor of cyclo-oxygenase, ibuprofen. Ibuprofen-treated platelets recovered nearly completely immediately on being resuspended in drug-free plasma. When microsomes were isolated from platelets, then treated with indomethacin, no time-dependent recovery of activity was seen. The recovery of cyclo-oxygenase after indomethacin inhibition appears to be limited to the unperturbed enzyme in its natural milieu.