Abstract
Purpose
To examine the central nervous system side effects of the non-steroidal anti-inflammatory drug (NSAID) indomethacin in a case-series of obstetric patients.
Methods
The hospital records of patients experiencing any post-partum complication between 1994 and 1999 were reviewed for adverse drug reactions (ADR) attributed to indomethacin. Additional cases of indomethacin-induced adverse effects were identified through reports to the nursing administration and the Saskatchewan ADR reporting program. The Naranjo ADR probability scale was applied to all cases.
Results
Thirty-two patients experienced a psychiatric reaction after receiving indomethacin for postpartum pain. The symptoms were often severe and included dizziness, anxiety, fear, agitation, affective lability, depersonalization, paranoia, and hallucinations. There was no past psychiatric history documented in any of the cases.
Conclusion
This study identifies a possible ADR to indomethacin occurring in postpartum patients. Whether the vulnerability to these neuropsychiatric reactions is randomly distributed or if parturients are at increased risk is yet to be determined. Proposed mechanisms of these side effects include a postpartum dopamine supersensitivity exacerbated by prostaglandin inhibition as well as a structural similarity between serotonin and indomethacin. The severity of the reactions to indomethacin in parturients and the potential for these disturbing psychiatric side effects to compromise the safety of both mother and infant have led to the use of alternative analgesics including different classes of NSAIDs for this population at our institution.
Résumé
Objectif
Vérifier les effets secondaires centraux d’un anti-inflammatoire non stéroïdien (AINS), l’indométhacine, dans une série de cas d’obstétrique.
Méthode
Nous avons passé en revue les dossiers hospitaliers des patientes qui avaient subi des complications postpartum causées par des effets indésirables des médicaments (EIM), en l’occurrence l’indométhacine, entre 1994 et 1999. D’autres cas reliés à l’indométhacine provenaient de déclaration faite à l’administration des soins infirmiers et au programme de déclaration des EIM de la Saskatchewan. L’échelle de probabilité d’EIM de Naranjo (Naranjo ADR probability scale) a été appliquée à tous les cas.
Résultats
Trente-deux patientes ont subi une réaction psychiatrique à l’indométhacine reçue pour la douleur du postpartum. Les symptômes, souvent sévères, comprenaient : étourdissements, anxiété, crainte, agitation, labilité de l’affect, dépersonnalisation, paranoïa et hallucinations. Aucune de ces femmes n’avait d’antécédents psychiatriques.
Conclusion
L’étude montre un EIM possible de l’indométhacine chez des patientes en postpartum. Il reste à déterminer si la vulnérabilité à ces effets neuropsychiatriques est aléatoirement distribuée ou si les parturientes sont plus à risque. On croit que ces effets secondaires pourraient relever d’une hypersensibilité postpartum à la dopamine, qui serait exacerbée par l’inhibition de prostaglandine, ou d’une similarité structurelle entre la sérotonine et l’indométhacine. La sévérité des réactions à l’indométhacine chez les parturientes et leur potentiel de compromettre la sécurité de la mère et de l’enfant ont incité à utiliser d’autres analgésiques, y compris les différentes classes d’AINS, pour cette catégorie de patientes à notre institution.
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Clunie, M., Crone, LA., Klassen, L. et al. Psychiatric side effects of indomethacin in parturients. Can J Anesth 50, 586–588 (2003). https://doi.org/10.1007/BF03018645
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DOI: https://doi.org/10.1007/BF03018645