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About - Indomethacin

By mouth: Treats pain. This is an NSAID.

By injection: Used in premature babies born with heart disease such as patent ductus arteriosus.

Into the rectum: Treats arthritis and gout. This medicine is an NSAID.

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Respiratory and long‐term neurosensory outcomes are common morbidities among extremely low birth weight (ELBW),(birth weight less than 1000 g) survivors. Patent ductus arteriosus (PDA), a connection between vessels of the heart, is one of the known causes of respiratory morbidity. Indomethacin (a drug given early to close PDA) prophylaxis studies fail to show an improvement in the incidence of respiratory and long‐term outcomes, although there is a 50% reduction in the incidence of PDA. The addition of fluid restriction to indomethacin therapy might prove helpful. However, our review found no studies to answer this question.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 6, 2011

Indometacin is a non‐steroidal anti‐inflammatory drug (NSAID) used for treating postoperative pain. This review found only one small study of women with post‐episiotomy pain where the effectiveness of the drug (taken by mouth) was compared with a placebo. Conclusions about the effectiveness of orally administered indometacin cannot be made until more studies are undertaken.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 18, 2004

Dopamine has not been shown to prevent adverse effects of indomethacin on the kidneys of preterm babies. Indomethacin is a drug used in preterm babies to prevent brain hemorrhage or to help close off PDA (patent ductus arteriosus ‐ when a channel between the lungs and heart does not close off after birth as it should). Indomethacin often causes fluid retention and reduced flow of urine, which can sometimes cause deterioration in kidney (renal) function. The drug dopamine is sometimes used along with indomethacin to try and prevent negative impact on the kidneys. The review found there is not enough evidence from trials to show there is any value in giving dopamine to babies being treated with indomethacin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 22, 2002

Patent ductus arteriosus (PDA) occurs when an artery near the heart and lungs, which should close off soon after birth, stays open. Babies born preterm (premature) who have a PDA are at higher risk of severe illness and death. Indomethacin, a drug more commonly used for muscle and bone pain in adults, when given to preterm infants can help close a PDA. This review found evidence that giving all preterm infants (especially very preterm infants) indomethacin on the first day after birth reduced their risk of developing a PDA and the complications associated with PDA (including brain damage due to bleeding into the brain). However, despite these short term effects, the trials found evidence that indomethacin does not increase survival or reduce disability in the longer term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 7, 2010

Patent ductus arteriosus (PDA) occurs when an artery near the heart and lungs stays open and does not close off after birth. Babies born early (preterm) have an increased risk of complications and death due to PDA. Indomethacin has been used to close the PDA; however, it can reduce blood flow in organs such as brain, kidneys and intestine. There is no agreement on the ideal dose and duration of treatment with indomethacin. In order to reduce the adverse effects of indomethacin on blood flow, some investigators have recommended administering the same total dose as a continuous infusion over 36 hours. In this review, the analysis of the two eligible trials found that the data was insufficient to reach a conclusion regarding the effectiveness of the 36‐hr continuous infusion method. The blood flow lowering side‐effects of indomethacin were reduced by the continuous infusion method, but there was insufficient data to recommend this administration method versus the traditional method.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 23, 2008

Extensive evidence implicates inflammatory processes in the pathogenesis of Alzheimer's disease. Non‐steroidal anti‐inflammatory drugs such as indomethacin have been proposed for the treatment of patients with Alzheimer's disease. Only one study met criteria for inclusion. In this one selected trial, authors did not carry out statistical analyses on the absolute change from baseline, but on the percentage change from the baseline score. Taking into account the difficulties in evaluating a single trial, at present there is no indication for treatment of mild to moderate Alzheimer's disease with indomethacin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 22, 2002

There is no strong evidence of benefit from routine use furosemide, a loop diuretic, in preterm babies receiving indomethacin for treatment of patent ductus arteriosus. A blood vessel (ductus arteriosus), which is required for blood circulation for the fetus in the womb, closes soon after birth in babies born around the expected date of delivery (term infants). Babies born early (preterm) may develop symptoms if they do not close that blood vessel after birth. Preterm infants who have symptoms due to the ductus arteriosus may receive therapy (indomethacin) for closing that vessel. Indomethacin may decrease kidney function and the amount of urine. Furosemide, a medication which reduces body water (diuretic), might help limit the effects of indomethacin on the kidney. This review analyzed the effects of furosemide on preterm babies receiving indomethacin to close the ductus arteriosus. The review of trials found not enough evidence to recommend routine use of furosemide in preterm infants who receive indomethacin for closing a ductus arteriosus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 23, 2001

Indomethacin for very preterm or small babies with signs of PDA but no symptoms can prevent PDA, but more research is needed on long‐term outcomes. A common complication for very preterm (premature) or very small babies is PDA (patent ductus arteriosus). PDA is an open channel between the lungs and heart which should have closed after birth, and can cause life‐threatening complications. Indomethacin is often given to all babies at risk to prevent PDA, but it can cause adverse effects. It can also be given only to those babies who have early signs of PDA, but who have not yet developed symptoms. The review of trials found that this selective use of indomethacin can prevent PDA and has short‐term benefits, but more research is needed on longer term outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 20, 2003

The ductus arteriosus is a blood vessel that connects the aorta and pulmonary artery. The ductus arteriosus is normally present in the fetus. It allows the majority of the output of the right side of the heart to bypass the lungs and supply the body of the fetus and placenta in‐utero. In most term infants the patent ductus arteriosus (PDA) closes within days of birth, first by contraction of a muscular layer to achieve functional closure and then by endothelial remodeling. If the ductus arteriosus persists, blood is shunted from the aorta to the pulmonary circulation, which can cause overloading of the pulmonary circulation and reduced perfusion of the brain, gut and kidneys. In preterm infants, closure may be delayed or fail to occur, due in part to circulating vasodilatory prostaglandins. Indomethacin inhibits prostaglandin synthesis and it is used to treat PDA in preterm infants. Although indomethacin is successful in closing the PDA in the majority of cases, the ductus will re‐open in up to 35% of infants who initially respond to the drug and a more prolonged course of indomethacin has been studied to achieve higher rates of ductal closure. Important side effects of indomethacin include renal dysfunction, decreased platelet aggregation, and necrotizing enterocolitis (NEC). Where indomethacin fails, the ductus arteriosus may be surgically ligated if clinically indicated. Five randomized trials are included in this review. These studies were published between 1988 and 2000 and included a total of 431 preterm and low birth weight infants. Indomethacin was given intravenously in four trials and orally in one, in total amounts of 0.6 to 1.6 mg/kg for the prolonged course (six to eight doses) and 0.3 to 0.6 mg/kg for the short course (two to three doses). There was no significant benefit of prolonged indomethacin administration on failure of the PDA to close after completion of allocated treatment (four studies, 361 infants). Prolonged course of indomethacin compared to the short course did not reduce the rate of PDA re‐opening after initial closure (three studies, 322 infants), rate of PDA re‐treatment (five studies, 431 infants), or ligation rate (four studies, 310 infants). The prolonged course was associated with decreased incidence of renal function impairment (three studies, 318 infants). However, a prolonged indomethacin course increased the risk of NEC (four studies, 310 infants). The number of deaths was no different.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 18, 2007

The way an infant's blood is circulated changes soon after birth. Initially, premature infants have an opening (a patent ductus arteriosus, PDA) between the large blood vessel to the lungs and the large blood vessel that carries oxygenated blood to the rest of the body. Early symptomatic treatment of PDA, when clinical signs first appear, helps reduce the amount of time an infant needs assisted breathing (mechanical ventilation) and the likelihood of chronic lung disease and damaging inflammation of the gut (necrotising enterocolitis). Standard therapy includes restricting fluids, diuretics and cyclooxygenase inhibitors like indomethacin or ibuprofen. The PDA is closed surgically if these medical treatments do not work. Only one randomised controlled study could be included in this review (including 154 preterm infants that needed breathing support). Indomethacin and surgery gave similar benefits. There were no differences in deaths during the hospital stay, chronic lung disease, necrotising enterocolitis, cerebral or other bleeding. Surgery was more effective in closing the PDA (three needed to treat for one to benefit) but it was associated with complications (pneumothorax and retinopathy of prematurity). The one study found was carried out over 30 years ago. Clinical practice has changed a great deal and surgical closure of a PDA is safer. Therefore, whether the results of the study are applicable today is debatable. Updates of this review in July 2007 and February 2012 did not identify any additional randomised controlled studies for inclusion, but three observational studies indicated an increased risk for one or more of the following outcomes associated with PDA ligation: chronic lung disease, retinopathy of prematurity and neurosensory impairment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 28, 2013

Cystoid macular oedema (CMO) is the accumulation of fluid in the macula (central retina) due to leakage from capillaries. Clinically significant CMO following cataract surgery is a complication of unknown cause. Acute CMO, defined as oedema of less than four months duration, often gets better spontaneously. This review included seven randomised controlled trials with a total of 266 participants. Four trials studied the effects of non‐steroidal anti‐inflammatory agents (NSAIDs) in chronic CMO while the other three examined the effect of NSAIDs in acute CMO. This review found two trials which showed that topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) has a positive effect on chronic CMO and a third trial which was supportive of this finding (albeit not statistically significantly so). One study suggested no effect and our review suggests further work is needed for a more conclusive decision regarding use of NSAIDS in chronic CMO. Similarly, the effects of NSAIDs in acute CMO remain unclear and this too needs further investigation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 15, 2012

‐ there is no precise information about side effects and complications. Only a minority of the patients treated with the steroid oral prednisolone reported minor side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 23, 2008

A substantial proportion of women who have an episode of threatened preterm labour (before 37 weeks) are actively treated with agents that stop the uterine contractions (tocolytic therapy) and they do not progress to give birth. After being successfully treated for an episode of threatened preterm birth, women may then take medication (tocolytics) to prolong gestation so that their baby is not born too early. Medications used for this purpose include betamimetics, magnesium sulphate, calcium channel blockers and COX inhibitors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 12, 2012

Corticosteroid drugs can relieve inflammation, and in high doses they have a dramatic effect on the symptoms of rheumatoid arthritis. They are used only temporarily, however, because of serious adverse effects during long‐term use. The review found that corticosteroids in low doses are very effective. They are more effective than usual anti‐arthritis medications (non‐steroidal anti‐inflammatory drugs, or NSAIDs). The risk of harms needs to be considered, however, especially the risk of fractures and infections.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 24, 2005

Not enough evidence on whether COX inhibitors administered to women in threatened premature labour may reduce the risk of babies being born too early.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 5, 2015

This summary of a Cochrane review presents what we know from research about the effect of muscle relaxants on pain in patients with rheumatoid arthritis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 18, 2012

A common complication for very preterm (premature) or very small babies is PDA. PDA is an open vascular channel between the lungs and the heart. It should close after birth, but sometimes remains open because of the baby's immature stage of development. PDA can lead to life‐threatening complications. The usual treatment for PDA has been indomethacin, a medicine that will successfully close the PDA in the majority of babies, but can cause serious side effects. Another option is the drug ibuprofen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 18, 2015

Acute renal colic is the pain caused by the blockage of urine flow secondary to urinary stones. The prevalence of kidney stone is thought to be between 2% to 3%, and the incidence has been increasing in recent years due to changes in diet and lifestyle. The renal colic pain is usually a sudden intense pain located in the flank or abdominal areas. This usually happens when a urinary stone blocks the ureter (the tube connecting the kidneys to the bladder). Different types of pain killers are used to ease the discomfort. Nonsteroidal anti‐inflammatory drugs (NSAIDs) and antispasmodics (treatment that suppresses muscle spasms) are used commonly to relieve pain and discomfort. This review aimed to assess the effectiveness of commonly used non‐opioid pain killers in adult patients with acute renal colic pain. Fifty studies enrolling 5734 participants were included in this review. Treatments varied greatly and combining of studies was difficult. We found that overall NSAIDs were more effective than other non‐opioid pain killers including antispasmodics for pain reduction and need for additional medication. We also found that the combining NSAIDs with antispasmodics did not increase the efficacy. No serious adverse effects were reported by any of the included studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 29, 2015

Lumbar puncture is an invasive procedure that medical personnel use to get a sample of cerebrospinal fluid for diagnostic purposes (e.g. to diagnose meningitis or subarachnoid haemorrhage) by inserting a needle into the lower spinal region. It can also be used to inject medications such as anaesthetics and analgesics (to perform regional anaesthesia), chemotherapy or radiological contrast agents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 28, 2013

Pericarditis is the inflammation and swelling of the tissue covering the outer layer of the heart. Pericarditis causes severe and disabling chest pain and fever, however the main issue is the repeated recurrence of pericarditis attacks. Colchicine is an ancient medication that has been used in the treatment of other inflammatory diseases such as gout.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 28, 2014

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