Pharmacokinetics of oral ibuprofen for patent ductus arteriosus closure in preterm infants

Amitai, Yona; Hammerman, Cathy

doi:10.1136/fetalneonatal-2011-301204

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…Both have been assessed in recent studies: continuous infusion led to better outcome and a simulation study suggests twice daily intravenously instead of once daily 3 4. Another hypothesis is based on haemodynamics where oral uptake should have a more ‘direct’ path leading to higher concentrations in the heart, but it seems highly unlikely that an absorption through the gut should be more ‘direct’ than an intravenous infusion through a long-line catheter ending near the right atrium 5…”

mentioning

confidence: 99%

Patent ductus arteriosus closure: why same-dose oral ibuprofen is superior to intravenous

Jensen

Kampmann

Andersen³

2019

Arch Dis Child Fetal Neonatal Ed

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mentioning

confidence: 99%

Patent ductus arteriosus closure: why same-dose oral ibuprofen is superior to intravenous

Jensen

Kampmann

Andersen³

2019

Arch Dis Child Fetal Neonatal Ed

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“…Enteral acetaminophen seems to have more treatment effects than the parenteral route. The reason to explain this may be from the steadier plasma levels of the drug administered orally, similar to the oral use of ibuprofen [ 111 ]. Liver toxicity from acetaminophen was considered for composite risk, but no data on long-term side effects, e.g., neurodevelopment, were reported.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Various Pharmacologic Agents in the Management of Hemodynamically Significant Patent Ductus Arteriosus in Preterm: A Network Meta-Analysis and Risk-Benefit Analysis

et al. 2022

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Introduction: Various pharmacological treatments are available for preterm infants with patent ductus arteriosus (PDA), but their risks and benefits are controversial. This study aimed to identify the best treatment for PDA using network meta-analysis (NMA) and risk-benefit assessment (RBA). Methods: Relevant randomized controlled trials (RCTs) were identified from MEDLINE, Scopus, and the Cochrane Library. RCTs were eligible if they were studied for preterm or low birth weight infants with presymptomatic PDA and hemodynamically significant PDA (hsPDA). The outcomes were PDA closure for a benefit and the composite risk outcome of adverse effects (AEs) for risk. An NMA was used to estimate the treatment effects of benefit and risk. The RBA helped to incorporate the risk and benefits of multiple treatments. Then, an incremental risk-benefit ratio was calculated by dividing the incremental risk by benefit using data from NMA, and they were jointly simulated using Monte Carlo methods. Finally, net clinical benefit (NCB) probability curves were constructed at varying acceptability thresholds. Results: Seventy RCTs with hsPDA were eligible considering 13 different interventions, but data on presymptomatic PDA were not enough for pooling. The clustered ranking plot from NMA indicated that 3 interventions (i.e., high-dose oral ibuprofen, standard-dose oral acetaminophen, and standard-dose oral ibuprofen) yielded high PDA closure and low AE. These three treatments and additional commonly used indomethacin were considered in the RBA. Given an acceptable threshold of 25% or having one AE out of four PDA closures, high-dose oral ibuprofen had a 36% chance of having the highest NCB, followed by standard-dose oral acetaminophen (27%), and oral ibuprofen (23.7%). Subgroup analysis indicated that the chances of having the highest NCB of GA ≥28 weeks were similar to that of all available studies. The best for GA <28 weeks, no data for high-dose oral ibuprofen, was standard-dose oral acetaminophen, followed by standard-dose oral ibuprofen. Conclusions: Trade-off RBA indicated that high-dose oral ibuprofen might be the best treatment for preterm, GA ≥28 weeks, with hsPDA followed by the standard-dose oral acetaminophen and ibuprofen. Preferably, optimal high doses, postnatal age to start treatment, and long-term outcomes are needed to study in the future.

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“…They concluded that oral ibuprofen administration was associated with excellent absorption and a high area under curve 0→24 value. However, as it is stated clearly in the article of Amitai et al., 33 this explanation of oral ibuprofen superiority is problematic because studies regarding pharmacokinetics of ibuprofen do not directly compare the IV form with the oral form and their statistical and clinical reliability is low since they are performed in different patient populations using different study protocols and methodology. Furthermore, in these studies, recommended dose scheme for oral ibuprofen is exactly the same of the IV form that makes it difficult to believe the oral form reaching the same ductal site‐specific drug levels with the IV form.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Oral and Intravenous Ibuprofen for Medical Closure of Patent Ductus Arteriosus: Which One Is Better?

Olukman¹,

Çalkavur²,

Ercan³

et al. 2012

Congenit Heart Dis

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Oral ibuprofen therapy is as efficacious as intravenous ibuprofen with some concerns about increased sepsis and bronchopulmonary dysplasia incidence. However, comprehensive and large-scale pharmacokinetic studies are required in order to prove this efficacy. On the other hand, intravenous ibuprofen still remains to be the drug of choice for patent ductus arteriosus but only with meticulous control of serum sodium levels in smaller infants.

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Pharmacokinetics of oral ibuprofen for patent ductus arteriosus closure in preterm infants

Cited by 6 publications

References 6 publications

Patent ductus arteriosus closure: why same-dose oral ibuprofen is superior to intravenous

Patent ductus arteriosus closure: why same-dose oral ibuprofen is superior to intravenous

Comparison of Various Pharmacologic Agents in the Management of Hemodynamically Significant Patent Ductus Arteriosus in Preterm: A Network Meta-Analysis and Risk-Benefit Analysis

Comparison of Oral and Intravenous Ibuprofen for Medical Closure of Patent Ductus Arteriosus: Which One Is Better?

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