Which medication should be included when discussing medical closure of a patent ductus arteriosus (PDA)?

Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), is an important medication used in the medical management of patent ductus arteriosus (PDA) in neonates. It functions by inhibiting the enzymatic activity of cyclooxygenase, which results in decreased prostaglandin E levels. Prostaglandin E is essential for maintaining the patency of the ductus arteriosus. By lowering its levels, indomethacin promotes the constriction and eventual closure of the ductus, which is often necessary to prevent complications such as heart failure or respiratory distress caused by excess blood flow to the lungs.

In the context of neonates, especially premature infants, medical closure of the PDA is critical because an open ductus can lead to significant morbidities. Indomethacin is widely studied and utilized for this purpose, demonstrating effectiveness and safety.

While other medications like ibuprofen also have a role in PDA management due to similar mechanisms of action, indomethacin is the traditional choice and has established guidelines supporting its use. Aspirin and acetaminophen, on the other hand, do not have the same efficacy or established use for PDA closure.