title: Protective effect of misoprostol on indomethacin induced renal dysfunction in elderly patients.
abstract: OBJECTIVE
  To evaluate the possible protective effects of misoprostol on renal function in hospitalized elderly patients treated with indomethacin.
  
  
  METHODS
  Forty-five hospitalized elderly patients (> 65 years old) who required therapy with nonsteroidal antiinflammatory drugs (NSAID) were randomly assigned to receive either indomethacin, 150 mg/day (Group A), or indomethacin 150 mg/day plus misoprostol at 0.6 mg/day (Group B). Laboratory variables of renal function [serum creatinine, blood urea nitrogen (BUN) and electrolytes] were evaluated before initiation of therapy and every 2 days, until termination of the study (a period of at least 6 days). Response to treatment was estimated by the visual analog scale for severity of pain.
  
  
  RESULTS
  Forty-two patients completed the study, 22 in Group A and 20 in Group B. BUN and creatinine increased by > 50% of baseline levels in 54 and 45% of Group A patients, respectively, compared to only 20 and 10% of Group B patients (p < 0.05). Potassium (K) increment of 0.6 mEq/l or more was observed in 50% of Group A, but in only 15% of Group B patients (p < 0.05). The mean increments in BUN, creatinine, and K were reduced by 63, 80, and 42%, respectively, in Group B patients compared to Group A. Response to treatment did not differ significantly between the 2 groups.
  
  
  CONCLUSIONS
  Hospitalized elderly patients are at risk for developing indomethacin related renal dysfunction. Addition of misoprostol can minimize this renal impairment without affecting pain control.
authors.affiliation: Department of Internal Medicine, Shaare-Zedek Medical Center, Jerusalem, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Nesher
authors.forename: M
authors.initials: M
authors.lastname: Sonnenblick
authors.forename: T
authors.initials: T
authors.lastname: Dwolatzky
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects*; D007674:Kidney Diseases / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D016595:Misoprostol / Q000627:therapeutic use*; D010146:Pain; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D016595:Misoprostol; D007213:Indomethacin