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Differential renal adverse effects of ibuprofen and indomethacin in preterm infants: a review

Authors Pacifici GM

Received 18 December 2013

Accepted for publication 11 March 2014

Published 31 July 2014 Volume 2014:6 Pages 111—116


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Gian Maria Pacifici

Medical School, Department of Translational Research and New Technologies in Medicine and Surgery, Section of Pharmacology, University of Pisa, Pisa, Italy

Objective: The objective of this study was to evaluate the extent of renal adverse effects caused by ibuprofen or indomethacin in order to choose the safer drug to administer to preterm infants.
Methods: The following three parameters of renal function were taken into consideration: 1) the urine output; 2) the serum creatinine concentration; and 3) the frequency of oliguria. The bibliographic search was performed using PubMed and Embase databases as search engines.
Results: Urine output ranged from 3.5±1.2 to 4.0±1.4 mL/kg/h after ibuprofen treatment, and from 2.8±1.1 to 3.6±1.4 mL/kg/h after indomethacin treatment. The values for ibuprofen are significantly (P<0.05) higher than those for indomethacin. The serum creatinine concentrations ranged from 0.98±0.24 to 1.48±0.2 mg/dL after ibuprofen treatment, and from 1.06±0.24 and 2.03±2.10 mg/dL after indomethacin treatment. The values for ibuprofen are significantly (P<0.05) lower than those for indomethacin. The frequency of oliguria ranged from 1.0% to 9.6% (ibuprofen) and from 14.8% to 40.0% (indomethacin), and was significantly lower following ibuprofen than indomethacin administration. In infants with body weight lower than 1,000 g, oliguria appeared in 5% (ibuprofen) and 40% (indomethacin; P=0.02).
Conclusion: Indomethacin is associated with more severe renal adverse effects than ibuprofen. Ibuprofen is less nephrotoxic than indomethacin and should be used to treat patent ductus arteriosus in preterm infants. Immaturity increases the frequency of adverse effects of indomethacin.

Keywords: ibuprofen, indomethacin, patent-ductus-arteriosus, renal-side-effects

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