Comparison of the effect of two drugs paracetamol with intravenous ibuprofen in patent ductus arteriosus treatment

Authors

  • Mehrdad Mirzarahimi Department of Pediatrics, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
  • Ramin Emamzadeghan Department of Pediatrics, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
  • Afsaneh Enteshari Moghaddam Department of Internal Medicine, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
  • Narges Falsafi School of Medicine, Ardabil University of Medical Science, Ardabil, Iran

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20201741

Keywords:

Ibuprofen, Paracetamol, PDA, Liver markers, Renal markers

Abstract

Background: Patent ductus arteriosus (PDA) is a common cause of morbidity and mortality among premature infants that affects more than 40% of them. PDA treatment includes medical and surgical treatment. Most drugs used to block PDA are cyclooxygenase inhibitors (ibuprofen and indomethacin). The role of paracetamol as an alternative therapy in PDA ligation has been considered in recent years due to the potential side effects of cyclooxygenase inhibitors.

Methods: Patients in the first group were treated with intravenous paracetamol at a dose of 15 mg/kg every 6 hours for three days and the second group was treated with intravenous ibuprofen at a daily dose of 10 mg/kg daily and 5 mg/kg for the second and third days. At the end of the treatment period (day 3), they underwent echocardiography again. If the echocardiographic findings indicated no closure of the arterial duct, patients were treated with the aforementioned drug for another period and rechecked at the end of the third day, and at each stage required information was collected.

Results: Arterial duct closure in paracetamol group was 96.7% and in ibuprofen group was 100%. The effects of both paracetamol and ibuprofen were similar in terms of renal parameters but in terms of effects on liver parameters. The effect of paracetamol on all liver parameters except aspartate transaminase (AST) was significant, but ibuprofen was able to affect only bilirubin among liver parameters and had no significant effect on both AST and alanine aminotransferase, parameters.

Conclusions: Results showed that both paracetamol and ibuprofen are effective in treating of PDA and had similar impact.

References

Strauss T, Pessach I, Jacoby E, Eisen SI, Mazkereth R, Kuint J. Carina angle measurements for diagnosis of patent ductus arteriosus in preterm infants. Neonatology. 2011;99:224-30.

Overmeire BV, Chemtob S. The pharmacologic closure of the patent ductus arteriosus. In Seminars in Fetal Neonatal Med. 2005;10;177-84.

Noori S. Patent ductus arteriosus in the preterm infant: to treat or not to treat. J Perinatol. 2010;30:31.

Demirel G, Erdeve O, Dilmen U. Pharmacological management of PDA: oral versus intravenous medications. Current Clin Pharmacol. 2012;7:263-70.

Erdeve O, Yurttutan S, Altug N, Ozdemir R, Gokmen T, Dilmen U, et al. Oral versus intravenous ibuprofen for patent ductus arteriosus closure: a randomised controlled trial in extremely low birthweight infants. Arch Dis Childhood-Fetal Neonatal Edition. 2012;97:279-83.

Gokmen T, Erdeve O, Altug N, Oguz SS, Uras N, Dilmen U. Efficacy and safety of oral versus intravenous ibuprofen in very low birth weight preterm infants with patent ductus arteriosus. J Pediatr. 2011;158:549-54.

Oncel MY, Yurttutan S, Degirmencioglu H, Uras N, Altug N, Erdeve O. Intravenous paracetamol treatment in the management of patent ductus arteriosus in extremely low birth weight infants. Neonatol. 2013;103:166-9.

Erdeve O, Gokmen T, Altug N, Dilmen U. Oral versus intravenous ibuprofen: which is better in closure of patent ductus arteriosus. Pediatrics. 2009;123:763.

Zecca E, Romagnoli C, Carolis DMP, Costa S, Marra R, Luca D. Does ibuprofen increase neonatal hyperbilirubinemia. Pediatrics. 2009;124:480-4.

Erdeve O, Sarici SU, Sari E, Gok F. Oral-ibuprofen-induced acute renal failure in a preterm infant. Pediatr Nephrol. 2008;23:1565-67.

Green K, Drvota V, Vesterqvist O. Pronounced reduction of in vivo prostacyclin synthesis in humans by acetaminophen (paracetamol). Prostaglandins. 1989;37:311-5.

Lucas R, Warner TD, Vojnovic I, Mitchell JA. Cellular mechanisms of acetaminophen: role of cyclo-oxygenase. FASEB J. 2005;19:635-37.

Hammerman C, Nun BA, Markovitch E, Schimmel MS, Kaplan M, Fink D. Ductal closure with paracetamol: a surprising new approach to patent ductus arteriosus treatment. Pediatrics. 2011;128:1618-21.

Oncel MY, Yurttutan S, Uras N, Altug N, Ozdemir R, Ekmen S, et al. An alternative drug (paracetamol) in the management of patent ductus arteriosus in ibuprofen-resistant or contraindicated preterm infants. Arch Dis Childhood-Fetal Neonatal Edition. 2013;98:94-8.

Oncel MY, Yurttutan S, Degirmencioglu H, Uras N, Altug N, Erdeve O. Intravenous paracetamol treatment in the management of patent ductus arteriosus in extremely low birth weight infants. Neonatology. 2013;103:166-9.

Mandhan P, Brown S, Kukkady A, Samarakkody U. Surgical closure of patent ductus arteriosus in preterm low birth weight infants. Congenital Heart Dis. 2009;4:34-7.

Habibi M, Nobakht M, Yazdi Z, Jangjoo T. Comparison of oral ibuprofen versus acetaminophen in infants with patent ductus arteriosus in Kosar Hospital; Qazvin-Iran. Master’s thesis, Qazvin University of medical sciences, Qazvin. Iran; 2016.

Dang D, Wang D, Zhang C, Zhou W, Zhou Q, Wu H. Comparison of oral paracetamol versus ibuprofen in premature infants with patent ductus arteriosus: a randomized controlled trial. PLoS One. 2013;8(11):77888.

Aikio O, Harkin P, Saarela T, Hallman M. Early paracetamol treatment associated with lowered risk of persistent ductus arteriosus in very preterm infants. J Matern Fetal Neonatal Med. 2014;27:1252-6.

Sinha R, Negi V, Dalal SS. An Interesting Observation of PDA Closure with Oral Paracetamol in Preterm Neonates. J Clin Neonatol. 2013;2:30-2.

Terrin G, Conte F, Scipione A, Bacchio E, Conti MG, Ferro R, et al. Efficacy of paracetamol for the treatment of patent ductus arteriosus in preterm neonates. Ital J Pediatr. 2014;40:21.

Yurttutan S, Oncel MY, Arayici S, Uras N, Altug N, Erdeve O, et al. A different first-choice drug in the medical management of patent ductus arteriosus: oral paracetamol. J Matern Fetal Neonatal Med. 2013;26:825-7.

Zacel MY, Yurttutan S, Erdeve O, Uras N, Altug N, Oguz SS. Oral paracetamol versus oral ibuprofen in the management of patent ductus arteriosus in preterm infants: a randomized controlled trial. J Pediatr. 2014;164:510-4.

Downloads

Published

2020-04-23

How to Cite

Mirzarahimi, M., Emamzadeghan, R., Enteshari Moghaddam, A., & Falsafi, N. (2020). Comparison of the effect of two drugs paracetamol with intravenous ibuprofen in patent ductus arteriosus treatment. International Journal of Basic & Clinical Pharmacology, 9(5), 690–694. https://doi.org/10.18203/2319-2003.ijbcp20201741

Issue

Section

Original Research Articles