Am J Perinatol 2010; 27(5): 425-429
DOI: 10.1055/s-0029-1243371
© Thieme Medical Publishers

Safety and Effectiveness of Indomethacin versus Ibuprofen for Treatment of Patent Ductus Arteriosus

Lakshmi I. Katakam1 , C. Michael Cotten1 , Ronald N. Goldberg1 , Chi N. Dang1 , P. Brian Smith1 , 2
  • 1Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
  • 2Duke Clinical Research Institute, Durham, North Carolina
Further Information

Publication History

Publication Date:
11 December 2009 (online)

ABSTRACT

We compared the rates of medical closure of patent ductus arteriosus (PDA) and complications (renal dysfunction, necrotizing enterocolitis, spontaneous intestinal perforation, and intraventricular hemorrhage) between infants treated with indomethacin and infants treated with ibuprofen. We performed a retrospective comparative cohort study of infants treated with indomethacin or ibuprofen for symptomatic PDA at Duke University Medical Center between November 2005 and November 2007. We identified 65 infants who received indomethacin and 57 who received ibuprofen. The rate of survival without surgical ductal ligation was 62% (40/65) in the indomethacin group and 58% (33/57) in the ibuprofen group (p = 0.71). The rate of the composite of complications (death, necrotizing enterocolitis, or intestinal perforation) was 40% (26/65) in the indomethacin group and 32% (18/57) in the ibuprofen group (p = 0.35). There was no significant difference between groups in elevation of serum creatinine during treatment. In clinical practice, ibuprofen appears to be as effective as indomethacin for closure of patent ductus arteriosus with similar complication rates. The decision to use one agent over the other should be based on dose schedule preference and the currently published clinical trials until more safety and effectiveness data are available.

REFERENCES

  • 1 Poon G. Ibuprofen lysine (NeoProfen) for the treatment of patent ductus arteriosus.  Proc (Bayl Univ Med Cent). 2007;  20 83-85
  • 2 Aranda J V, Clyman R, Cox B et al.. A randomized, double-blind, placebo-controlled trial on intravenous ibuprofen L-lysine for the early closure of nonsymptomatic patent ductus arteriosus within 72 hours of birth in extremely low-birth-weight infants.  Am J Perinatol. 2009;  26 235-245
  • 3 Aranda J V, Thomas R. Systematic review: intravenous ibuprofen in preterm newborns.  Semin Perinatol. 2006;  30 114-120
  • 4 Gimeno Navarro A, Cano Sánchez A, Fernández Gilino C et al.. [Ibuprofen versus indomethacin in the treatment of patent ductus arteriosus in preterm infants].  An Pediatr (Barc). 2005;  63 212-218
  • 5 Lago P, Bettiol T, Salvadori S et al.. Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus: a randomised controlled trial.  Eur J Pediatr. 2002;  161 202-207
  • 6 Sangtawesin C, Sangtawesin V, Lertsutthiwong W, Kanjanapattanakul W, Khorana M, Ayudhaya J K. Prophylaxis of symptomatic patent ductus arteriosus with oral ibuprofen in very low birth weight infants.  J Med Assoc Thai. 2008;  91(Suppl 3) S28-S34
  • 7 Sekar K C, Corff K E. Treatment of patent ductus arteriosus: indomethacin or ibuprofen?.  J Perinatol. 2008;  28(Suppl 1) S60-S62
  • 8 Su B H, Lin H C, Chiu H Y, Hsieh H Y, Chen H H, Tsai Y C. Comparison of ibuprofen and indomethacin for early-targeted treatment of patent ductus arteriosus in extremely premature infants: a randomised controlled trial.  Arch Dis Child Fetal Neonatal Ed. 2008;  93 F94-F99
  • 9 Van Overmeire B, Smets K, Lecoutere D et al.. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus.  N Engl J Med. 2000;  343 674-681
  • 10 Jobe A H. Drug pricing in pediatrics: the egregious example of indomethacin.  Pediatrics. 2007;  119 1197-1198
  • 11 Van Overmeire B, Follens I, Hartmann S, Creten W L, Van Acker K J. Treatment of patent ductus arteriosus with ibuprofen.  Arch Dis Child Fetal Neonatal Ed. 1997;  76 F179-F184
  • 12 Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants.  Cochrane Database Syst Rev. 2008;  (1) CD003481
  • 13 Watterberg K L, Gerdes J S, Cole C H et al.. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial.  Pediatrics. 2004;  114 1649-1657
  • 14 Pezzati M, Vangi V, Biagiotti R, Bertini G, Cianciulli D, Rubaltelli F F. Effects of indomethacin and ibuprofen on mesenteric and renal blood flow in preterm infants with patent ductus arteriosus.  J Pediatr. 1999;  135 733-738
  • 15 Plavka R, Svihovec P, Biolek J et al.. Ibuprofen vs. indomethacin in the treatment of patent ductus arteriosus (PDA) in very premature neonates.  Pediatr Res. 2001;  49 375A
  • 16 Giniger R P, Buffat C, Millet V, Simeoni U. Renal effects of ibuprofen for the treatment of patent ductus arteriosus in premature infants.  J Matern Fetal Neonatal Med. 2007;  20 275-283

P. Brian Smith

Duke Clinical Research Institute

PO Box 17969, Durham, NC 27715

Email: brian.smith@duke.edu