This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Clunie, M. L. Articles by Yip, R. W. Search for Related Content PubMed Articles by Clunie, M. L. Articles by Yip, R. W.

PSYCHIATRIC SIDE EFFECTS OF INDOMETHACIN IN PARTURIENTS

Department of Anesthesia, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8

INTRODUCTION

A perceived increase in adverse psychiatric reactions occurring in parturients receiving the non-steroidal anti-inflammatory drug (NSAID) indomethacin has been identified at our institution. This study examines and describes the central nervous system (CNS) side effects of indomethacin observed in a case-series of obstetric patients.

METHODS

The hospital records of obstetrical patients experiencing a post-partum complication between 1994 and 1999 were reviewed for adverse drug reactions attributed to indomethacin. Additional cases of indomethacin-induced side effects were identified through reports to both the nursing administration and the Saskatchewan Adverse Drug Reaction (ADR) Reporting Program. The Naranjo ADR Probability scale was applied to all cases.¹

RESULTS

Thirty-two cases of psychiatric reactions were identified in women receiving indomethacin for post-partum pain. The symptoms were severe, including dizziness, anxiety, fear, agitation, affective lability, depersonalization, paranoia, and hallucinations. The duration of psychiatric side effects was less than six hours. Benzodiazepines were administered to relieve symptoms in six cases. There was no past psychiatric history documented in any of the cases.

DISCUSSION

NSAID-induced CNS side effects have been described predominantly in the elderly population with indomethacin most frequently reported to produce psychiatric reactions.^2,3,4 Proposed mechanisms of these side effects include a prostaglandin-dopamine interaction, as well as a structural relationship between serotonin and indomethacin.^2,3 Whether the vulnerability to these neuropsychiatric reactions is randomly distributed or if parturients are at increased risk is yet to be determined. The possible etiologic role of a postpartum dopamine supersensitivity exacerbated by indomethacin is explored.^5,6 The severity of the reactions to indomethacin in parturients and the potential for these disturbing psychiatric side effects to compromise maternal bonding have led to the use of alternative analgesics including different classes of NSAIDs for this population.

REFERENCES

1 Clin Pharmacol Ther 1981;30:239-245. [Medline]

2 J Clin Psychopharmacol 1982;2:62–64.[Medline]

3 Arch Intern Med 1991;151:1309-1313. [Abstract]

4 Int'l J Psychiatry in Medicine1996;26:2534

5 J Clin Psychiatry 1990;51:365-366.[Medline]

6 Psychopharmacology 1991;103:95–98.[Medline]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Clunie, M. L. Articles by Yip, R. W. Search for Related Content PubMed Articles by Clunie, M. L. Articles by Yip, R. W.