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Acetaminophen for patent ductus arteriosus
Jennifer Le1, Mark A Gales2, Barry J Gales3
1Southwestern Oklahoma State University College of Pharmacy, Weatherford, OK, USA.
The Annals of Pharmacotherapy
|October 30, 2014
Summary
Acetaminophen is an effective alternative for treating patent ductus arteriosus (PDA) in preterm infants when other treatments fail or are contraindicated. It demonstrates comparable efficacy to ibuprofen and is generally well-tolerated.
Area of Science:
- Neonatal pharmacology
- Pediatric cardiology
- Evidence-based medicine
Background:
- Patent ductus arteriosus (PDA) is a common condition in preterm infants.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and indomethacin are standard PDA treatments.
- Alternative therapies are needed for cases where NSAIDs are ineffective or contraindicated.
Purpose of the Study:
- To evaluate the existing literature on acetaminophen use for PDA treatment.
- To assess acetaminophen's efficacy and safety as a PDA therapeutic option.
Main Methods:
- Systematic literature search of MEDLINE and article references.
- Inclusion of human clinical trials and case reports in English.
- Review of 12 case reports and 2 randomized controlled trials.
Main Results:
- Acetaminophen (oral or IV) achieved successful PDA closure in over 76% of cases reported.
- Randomized trials showed acetaminophen noninferior to ibuprofen in preterm infants (72.5%-81.2% closure rates).
- Common dosage: 15 mg/kg every 6 hours for 3 days; therapy generally well-tolerated with rare liver enzyme elevations.
Conclusions:
- Acetaminophen serves as a viable alternative for PDA treatment in preterm infants.
- It is particularly useful when indomethacin/ibuprofen are ineffective or contraindicated.
- Consideration of acetaminophen before surgical intervention is warranted.
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