Indomethacin thrombocytopenia with

Typical gastrointestinal adverse effects with naproxen occur at approximately the same frequency as with indomethacin, but perhaps with less severity. CNS side effects range from drowsiness, headache, dizziness, and sweating, to fatigue, depression, and ototoxicity. Less common reactions include pruritus and a variety of dermatological problems. A few instances of jaundice, impairment of renal function, angioedema, thrombocytopenia and agranulocytosis have been reported. 

Indomethacin is FDA approved for closure of persistent patent ductus arteriosus. Successful closure is obtained in >70% of neonates treated with the drug. Such therapy is indicated primarily in premature infants who weigh between 500 and 1750 g, who have a hemodynamically significant patent ductus arteriosus, and in whom other supportive maneuvers have been attempted. Unexpectedly, treatment with indomethacin also may decrease the incidence and severity of intraventricular hemorrhage in low-birth-weight neonates. The principal limitation of treating neonates is renal toxicity, and therapy is stopped if urine output falls to <0.6 mL/kg/h. Renal failure, enterocolitis, thrombocytopenia, or hyperbilirubinemia are contraindications to the use of indomethacin. 

Ibuprcfen is thought to be better tolerated than aspirin and indomethacin and has been used in patients with a history of gastrointestinal intolerance to other NSAIDs. Nevertheless, 5-15% of patients experience GI side effects. Less frequent adverse effects include thrombocytopenia, rashes, headache, dizziness, blurred vision, and in a few cases toxic amblyopia, fluid retention, and edema. Patients who develop ocular disturbances should discontinue the use of ibuprofen. Ibuprofen can be used occasionally by pregnant women however, the concerns apply regarding third-trimester effects. Excretion into breast milk is thought to be minimal, so ibuprofen also can he used with caution by women who are breastfeeding. 

---