Prenatal Sonographic Diagnosis of Premature Constriction of the Fetal Ductus Arteriosus After Maternal Self‐Medication With Benzydamine Hydrochloride

Abstract

We report 3 cases of prenatal diagnosis of premature constriction of the ductus arteriosus after maternal benzydamine hydrochloride therapy (3-mg lozenges) in third-trimester pregnancies. In each case, fetal echocardiography revealed a dilated, hypocontractile right ventricle with severe tricuspid regurgitation and constriction of the ductus arteriosus. Although the effect of indomethacin and other nonsteroidal anti-inflammatory drugs on prenatal ductal constriction is well known, readily available over-the-counter nonsteroidal anti-inflammatory drugs such as benzydamine can have an equally deleterious effect and are best avoided in the third trimester of pregnancy.

pyHeart4Fish: Chamber-specific heart phenotype quantification of zebrafish in high-content screens

“…Benzydamine HCl (BZY): The non-steroidal anti-inflammatory drug (NSAID) BZY inhibits phospholipase A 2 activity by preventing arachidonic acid release from phospholipids ( Turnbull, 1995 ; Passali et al, 2022 ). Additionally, it weakly inhibits prostaglandin endoperoxide H synthase 1 and 2 by decreasing prostaglandin production ( Blackwell et al, 1975 ; Modéer and Yucel-Lindberg, 1999 ; Krzeszowski et al, 2015 ). In this drug screen, BZY caused mild bradycardia (−1.16; n = 4) and decreased the max.…”

“…NSAIDs are also administered to close patent ductus arteriosus in preterm neonates ( Westhoff et al, 2020 ). In 2015, three cases of premature constriction of the fetal ductus arteriosus after maternal self-medication with BZY during pregnancy were reported ( Krzeszowski et al, 2015 ). Premature ductus arteriosus is associated with an increased risk of neonatal pulmonary hypertension ( Zenker et al, 1998 ; Chen et al, 2022 ).…”

Premature closure of ductus arteriosus after a single dose of diclofenac during pregnancy

“…By competing with arachidonic acid, classical NSAIDs such as diclofenac induce reversible non-selective cyclooxygenase (COX) inhibition, thereby inhibiting PGE2 synthesis, which is essential for maintaining DA patency during intrauterine life 44 45. As endothelial and smooth muscle cells of the DA express both COX isoforms,43 premature closure of DA is a possible side effect for all NSAIDs as a class and has been documented following maternal administration of most NSAIDs during pregnancy, with multiple formulations, including topical 46 47. This effect appears to be dose-independent and formulation-independent, but related to gestational age, mainly occurring during the third trimester.…”

La insuficiencia tricuspídea como marcador indirecto de la constrición o cierre prematuro del conducto arterioso: reporte de caso y revisión de la literatura

“…El diclofenaco, incluso de uso tópico, ha sido consistentemente asociado con la constricción ductal (12) . Asimismo, se ha reportado 3 casos de constricción ductal asociado al uso de bensidamina (13) ; y , por otro lado, existe asociación con el consumo de alimentos ricos en polifenoles; alimentos como el té negro y verde, té de mate, té de manzanilla, boldo, derivados de la uva, el chocolate negro, zumo de naranja, entre otros, se han relacionado con este problema, y se ha demostrado que su restricción durante el tercer trimestre mejora la constricción ductal no relacionada con AINES (14) . En el presente caso, el cuadro de constricción ductal estuvo asociado al uso de metamizol (dipirona), medicamento que actúa, entre otros mecanismos, como inhibidor de la síntesis de prostaglandinas.…”