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Indomethacin

Indometacin


Presentation

  • Once secondary causes have been ruled out, a trial of indomethacin should be considered in pediatric patients presenting with severe paroxysmal headaches, even if no autonomic symptoms are present.[ncbi.nlm.nih.gov]
  • It presents some autonomic features (including conjunctival injection, ptosis, eyelid edema, lacrimation, nasal congestion, and rhinorrhea). Response to indomethacin treatment is the mandatory criteria for the diagnosis of HC.[ncbi.nlm.nih.gov]
  • The patient is presently completing a 15-month follow-up and remains free ofrelapses.[ncbi.nlm.nih.gov]
  • There have been several case reports of patients presenting with short-lasting, frequent, bilateral headaches responding to indomethacin, without cranial autonomic features.[ncbi.nlm.nih.gov]
  • The objective of this article is to present the first post-traumatic/secondary case of LASH syndrome and the first melatonin-responsive case of LASH. We present a case report.[ncbi.nlm.nih.gov]
Congestive Heart Failure
  • PDA is a medical condition that creates complications, such as increased pulmonary blood flow, respiratory distress syndrome, and enlargement of the left ventricle and atrium, leading to congestive heart failure.[pharmacytimes.com]
  • Fluid overload in patients with congestive heart failure. In addition, some people have experienced potentially fatal, allergic-type reactions to indomethacin.[thegoutkiller.com]
  • The impairment is most likely to occur in patients with preexisting impairment of kidney function or congestive heart failure, and use of NSAIDs in these patients should be done cautiously.[medicinenet.com]
  • The impairment is most likely to occur in patients with preexisting impairment of kidney function or congestive heart failure , and use of NSAIDs in these patients should be done cautiously.[medicinenet.com]
Coarctation of the Aorta
  • KEYWORDS: Right aortic arch; coarctation of the aorta; left arterial duct[ncbi.nlm.nih.gov]
Turkish
  • The anxiety-depression status of the patients was evaluated using a validated Turkish version of the Beck anxiety-depression form before the procedure.[ncbi.nlm.nih.gov]
Normal Hearing
  • At 1 year of age the child was developing normally with normal hearing and no clinical sequelae of intrauterine CMV infection.[ncbi.nlm.nih.gov]
Urticaria
  • Cutaneous adverse effects include bruising from antiplatelet effects, urticaria secondary to NSAIDs as a class or to specific NSAIDs, chronic idiopathic urticaria aggravated by NSAIDs, dermatologic conditions aggravated by NSAIDs (eg dermatitis herpetiformis[aaaai.org]
  • […] drowsiness, tinnitus, confusion, light-headedness, insomnia, psychiatric disturbances, syncope, convulsions, coma, peripheral neuropathy, blurred vision and other ocular effects, oedema and weight gain, hypertension, haematuria, skin rashes, pruritus, urticaria[home.intekom.com]
  • TIVORBEX is contraindicated in patients with: a known hypersensitivity to indomethacin or its inactive ingredients; a history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.[tivorbexhcp.com]
  • -Patients in whom acute asthmatic attacks, urticaria, or rhinitis are precipitated by aspirin or other nonsteroidal anti- inflammatory agents.[druglib.com]
Alopecia
  • […] confusion, light-headedness, insomnia, psychiatric disturbances, syncope, convulsions, coma, peripheral neuropathy, blurred vision and other ocular effects, oedema and weight gain, hypertension, haematuria, skin rashes, pruritus, urticaria, stomatitis, alopecia[home.intekom.com]
Skin Lesion
  • In addition, systemic treatment with indomethacin reduced eosinophil CRTH2 expression in another patient in association with improvement of skin lesions and blood eosinophilia.[ncbi.nlm.nih.gov]
Headache
  • Sometimes, IMC has been found to provoke headache; differentiating IMC-provoked headache from IMC-resistant headache can make headache diagnosis and management difficult.[ncbi.nlm.nih.gov]
  • Indomethacin-responsive headache syndromes can be divided into several distinct categories: a select group of trigeminal-autonomic cephalgias, valsalva-induced headaches, and primary stabbing headache (ice-pick headache or jabs and jolts syndrome).[ncbi.nlm.nih.gov]
  • From day 25 on she was free of hypnic headache. On day 31 we tapered the daily dose of indomethacin to 50mg at bedtime, the patient was still without headache.[ncbi.nlm.nih.gov]
  • A dose of 150 mg of indomethacin/day reduced the headache by 80%. Although an increase to 225 mg/day led to a further reduction of headaches, a new onset of moderate to severe pulsating migrainous bilateral headache developed.[ncbi.nlm.nih.gov]
  • Different forms of idiopathic stabbing headaches have also been responsive to indomethacin, but less consistently than the others. Two cases of indomethacin-responsive headache are reported.[ncbi.nlm.nih.gov]
Confusion
  • The major adverse reactions associated with indomethacin therapy involve the central nervous system (headache, lightheadedness, vertigo, mental confusion) and the gastrointestinal tract (nausea, indigestion, epigastric burning, diarrhea, peptic ulceration[annals.org]
  • For this reason, it is fairly effective at knocking out a gout attack, but don’t be surprised if you end up with a stomach ulcer, dizziness, confusion, and/or bizarre nerve sensations.[thegoutkiller.com]
  • Some people experience mental side effects, including confusion and loss of touch with reality.[livestrong.com]
  • Other adverse effects may be depression, drowsiness, tinnitus, confusion, light-headedness, insomnia, psychiatric disturbances, syncope, convulsions, coma, peripheral neuropathy, blurred vision and other ocular effects, oedema and weight gain, hypertension[home.intekom.com]
  • Side effects also include reduction in red blood cells, bleeding, bruising or sore throats, aseptic meningitis which causes stiff necks, headaches, vomiting, nausea or fever, depression, axnxiety, disorientation, hallucinations, confusion, nervousness[oxfordonlinepharmacy.co.uk]
Seizure
  • Secondary long-term outcomes were hydrocephalus necessitating the placement of a shunt, seizure disorder, and microcephaly.[clinicaltrials.gov]
  • […] such as ulcerative colitis; Kidney or liver disease; High blood pressure or heart disease; History of chest pain (angina), heart problems or stroke; A tendency to bleed or other blood problems; Diabetes mellitus or sugar diabetes; Psychiatric problems; Seizures[myvmc.com]
  • […] problems such as ulcerative colitis kidney or liver disease high blood pressure or heart disease history of chest pain (angina), heart problems or stroke a tendency to bleed or other blood problems diabetes mellitus or sugar diabetes psychiatric problems seizures[nps.org.au]
Radiculopathy
  • A 48-year-old male patient presented with a complaint of left T9 radiculopathy. Computed tomography scan and magnetic resonance images showed a calcifying pseudotumor of the thoracic spine. The nature of this disease remains unknown.[ncbi.nlm.nih.gov]

Treatment

  • Efficacy of pharmacological treatment is influenced by timing of initiation of therapy. Surgical treatment is the only option when pharmacological treatment fails to close the PDA in symptomatic infants.[ncbi.nlm.nih.gov]
  • Thus, indomethacin should be considered as a first choice of treatment for EPF.[ncbi.nlm.nih.gov]
  • Treatment failure was also significantly associated with pre-treatment thrombocytopenia (summary OR:1.75; 95% CI:1.23-2.49, I2   36%, p heterogeneity 0.20).[ncbi.nlm.nih.gov]
  • The lesion was monitored with computed tomography and magnetic resonance imaging at 8 weeks and at 16 weeks after initiation of treatment. The patient had radicular pain for 8 weeks and sleep disturbance for 6 weeks prior to treatment.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis of AFOP is unfavorable, associated with the pathologic characteristics and the clinical parameters. CONCLUSIONS: The immune system activated by infection may play an important role in the pathogenesis of AFOP.[ncbi.nlm.nih.gov]

Etiology

  • Drugs of all types are related to the etiology of pancreatitis in approximately 1.4-2.0% of cases. We report the case of a 56-year-old man who presented with acute pancreatitis after a period of indomethacin therapy.[ncbi.nlm.nih.gov]
  • Major clinical differences 2 3 4 5 are listed in Table 1.As yet, etiologic studies have contributed little to the understanding of ankylosing spondylitis. 6 Heredity, trauma, psychologic stress and nonspecific urogenital infections have all been suggested[dx.doi.org]
  • . • Reversible cerebral vasoconstriction syndrome (RCVS) should be considered as possible underlying etiology before the diagnosis of primary headache associated with sexual activity. • Cluster headache may be also responsive to indomethacin.[medlink.com]

Epidemiology

  • Electronic address: jensene@email.chop.edu. 2 Division of Neonatology and Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA. 3 Biostatistics and Epidemiology Division, RTI International[ncbi.nlm.nih.gov]
  • Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer’s disease: a review of 17 epidemiologic studies. Neurology. 1996; 47:425-32. 478. Beard CM, Waring SC, O’sBrien PC et al.[drugs.com]
  • The Vågå study; epidemiology of headache I: the prevalence of ultrashort paroxysms. Cephalalgia 2001;21:207-215 14. Iordanidis T, Sjaastad O. Hemicrania continua: a case report. Cephalalgia 1989;9:301-303 15.[functionalneurology.com]
Sex distribution
Age distribution

Pathophysiology

  • This is the second Italian HH patient responsive to indomethacin, indicating that indomethacin may be a useful alternative treatment in HH patients, and providing further evidence in favour of a common pathophysiological mechanism in HH and other indomethacin-responsive[ncbi.nlm.nih.gov]
  • These cases may represent a novel indomethacin-responsive syndrome and therefore, for now, should be studied separately from PH until their pathophysiological basis is better understood.[ncbi.nlm.nih.gov]
  • Hypnic headache (HH) is considered as a disorder of the circadian rhythm, mostly affecting the elderly and generally considered a benign disorder, but the pathophysiology of hypnic hedache remains unclear.[ncbi.nlm.nih.gov]
  • Electronic address: catalinacarrasco@med.uchile.cl. 2 Pathophysiology Program, Faculty of Medicine, University of Chile, Av. Independencia 1027, Santiago, Chile, P.O.[ncbi.nlm.nih.gov]
  • Becker and Mandar Jog, Indomethacin‐Responsive Idiopathic Red Ear Syndrome: Case Report and Pathophysiology, Headache: The Journal of Head and Face Pain, 58, 2, (306-308), (2017).[doi.org]

Prevention

  • In addition, rectal indomethacin administration before ERCP is superior to its administration after ERCP for the prevention of PEP.[ncbi.nlm.nih.gov]
  • To address this, we conducted a meta-analysis of clinical trials specifically on rectal indomethacin in prevention of PEP in consecutive patients undergoing ERCP.[ncbi.nlm.nih.gov]
  • Of 623 patients at high risk for PEP, 145 were treated with prophylactic pancreatic stent placement (PSP) only, and 478 were treated with rectal indomethacin (RI) only, for PEP prevention.[ncbi.nlm.nih.gov]
  • Preventive administration of β-casofensin (100 μM) reduced intestinal macroscopic and microscopic damage induced by indomethacin. β-casofensin also prevented the depletion of goblet cells and increased myeloperoxidase activity, as well as tumor necrosis[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The combination of rectal indomethacin and intravenous normal saline before ERCP significantly prevents post-ERCP pancreatitis.[ncbi.nlm.nih.gov]

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