Incidence and outcome of a 10-fold indomethacin overdose in premature infants.

We reviewed the incidence and morbidity of a 10-fold medication error among all premature infants treated with indomethacin. We detected 4 incidents among 1059 indomethacin doses given to infants weighing less than 1000 g. None of the infants had intracranial hemorrhage, necrotizing enterocolitis, or significant deterioration of renal function.

Nonsteroidal anti-inflammatory drug toxicosis in dogs and cats: 240 cases (1989-1990)

A search of medical records at the Georgia Animal Poison Information Center over a 19-month period revealed 240 cases of dog and cat exposure to nonsteroidal anti-inflammatory drugs (NSAID). The most common NSAID consumed were ibuprofen, acetaminophen, aspirin, and indomethacin. The most common clinical signs of toxicosis were vomiting and diarrhea, CNS depression, and circulatory manifestations. Pets are at risk from NSAID toxicosis through administration by the owners or accidental consumption of improperly stored drugs.

Suspected central nervous system toxicity from inadvertent nonsteroidal antiinflammatory drug overdose.

This case illustrates a severe adverse reaction of the central nervous system involving a moderate overdose of diclofenac sodium along with therapeutic dosages of indomethacin and ibuprofen. Our patient became disoriented, hallucinated, lost consciousness, and suffered respiratory arrest after ingesting five diclofenac tablets (375 mg total), two ibuprofen tablets (400 mg total), and one indomethacin capsule (75 mg). Aggressive supportive therapy was instituted and the patient improved. She was awake, alert, and extubated in less than 24 hours with no serious sequelae.

Effects of highly overdosed indomethacin in a preterm infant with symptomatic patent ductus arteriosus.

We describe a preterm infant with severe idiopathic respiratory distress syndrome (iRDS, hyaline membrane disease) who needed artificial ventilation with high inspiratory pressure, high frequencies, 100% oxygen and developed a symptomatic patent ductus arteriosus (sPDA) in the course of the disease. The infant was given indomethacin to induce constriction of sPDA. Due to an error in drug dilution the patient received a 100-fold overdose of indomethacin. Compared to the normal study protocol side-effects such as renal failure were not observed probably due to sufficient fluid intake and good clinical condition prior to treatment and to the rapid and persistent ductal closure.

Indomethacin poisoning.

Two cases of indomethacin poisoning with supporting analytical data are described and the literature, which is limited to two reports, is reviewed. In overdose, indomethacin may produce the following non-life threatening symptoms: nausea, vomiting, abdominal pain, anorexia, drowsiness, headache, tinnitus, restlessness and agitation. The terminal elimination half-life in our two cases was respectively 6.8 hr and 2.9 hr which is similar to that found following a therapeutic dose.