Treatment of patent ductus arteriosus: indomethacin or ibuprofen?

Journal of perinatology : official journal of the California Perinatal Association (2008-06-18)
K C Sekar, K E Corff
ABSTRACT

Persistent patent ductus arteriosus (PDA) in preterm infants can result in serious hemodynamic changes causing respiratory, gastrointestinal and renal morbidities if not treated within the first week of life. The treatment options available are a conservative approach, pharmacological treatment with cyclo-oxygenase (COX) inhibitors and surgical ligation. The COX inhibitors approved for use in the United States are indomethacin and ibuprofen lysine. Both of these drugs are equally effective in closing the PDA. Subtle differences exist between these two preparations. Indomethacin has a protective effect on the incidence of intraventricular hemorrhage (IVH) but reduces the blood flow to the kidneys and the brain. Ibuprofen is less toxic but has no effect on IVH. Efficacy of pharmacological treatment is influenced by timing of initiation of therapy. Surgical treatment is the only option when pharmacological treatment fails to close the PDA in symptomatic infants. Long-term neurological and respiratory morbidities are associated with surgical ligation. This paper reviews these medical considerations in the treatment options for PDA in premature infants.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Indomethacin, 98.5-100.5% (in accordance with EP)
Supelco
Indomethacin, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Indomethacin, meets USP testing specifications
USP
Indomethacin, United States Pharmacopeia (USP) Reference Standard
Indomethacin, European Pharmacopoeia (EP) Reference Standard