Treatment of elevated intracranial pressure with indomethacin: friend or foe?
Indomethacin has been suggested as a therapeutic tool to manage elevated intracranial pressure in patients with severe head injury and patients undergoing craniotomy for brain tumors. Indomethacin is a non-selective cyclooxygenase inhibitor. Compared to other cyclooxygenase inhibitors indomethacin has unique effects on cerebral blood flow. Administration of indomethacin causes cerebral vasoconstriction and decreases cerebral blood flow, which elicits a decrease in intracranial pressure. The mechanism of indomethacin-induced cerebral vasoconstriction is not completely understood and controversies exist whether indomethacin causes cerebral ischemia. The primary aims of this article were to review the existing knowledge of indomethacin's influence upon cerebral hemodynamics and elevated ICP in patients with brain pathology. Furthermore, indomethacin's mechanism of action and whether it causes cerebral ischemia are discussed.
Rasmussen
M
M
Department of Neuroanesthesia, Arhus University Hospital, 8000 Arhus C, Denmark. maras@as.aaa.dk
D000818:Animals; D001921:Brain / Q000098:blood supply / Q000473:pathology; D001930:Brain Injuries / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003399:Craniotomy / Q000379:methods; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects / Q000627:therapeutic use*; D019586:Intracranial Hypertension / Q000188:drug therapy*; D010215:Papio; D051381:Rats; D013552:Swine
D016861:Cyclooxygenase Inhibitors; D007213:Indomethacin