Antipyretic effect of indomethacin in patients with malignancy

Abstract

The antipyretic effect of indomethacin in 30 febrile patients with malignancy was evaluated. Effective antipyresis was observed in 20 of the 30 patients. Responses were usually prompt and complete and side effects were reported infrequently. Defervescence was obtained much more frequently in those patients whose fever seemed related primarily to the neoplastic process rather than to a complicating infection. In eight patients indomethacin effected a defervescence after another antipyretic had failed to do so. The authors conclude that indomethacin should be considered as an alternate antipyretic in patients with malignancy complicated by fever.

Antipyretic Effect of Indomethacin in Malignant Lymphoma

“…A corresponding IM-induced lytic effect on fever is rarely seen in non-malignant febrile conditions; this was not the case with our AM1 patients either. Hypothermia was not seen after IM in febrile patients with hematological malignancies and verified bacteriological infections (11). In a small unpublished series of patients with septicemia we have made a similar observation.…”

“…Furthermore, the obligatory use of full-range thermometers must be underlined. Thus, the antipyretic effect of IM is well documented in fever-associated infections (15), other inflammatory states and malignant diseases including lymphoma (4,8,10,11,16). In HD, subnormal body temperatures have been seen following administration of IM, without hypotension or other manifestations of shock (10,11).…”

“…IM has also been observed to control fever in a number of patients with visceral cancers, and may act via its suppression of prostaglandin synthesis (4, 6). A subnormal body temperature after IM treatment as well as hypothermia after chemotherapy in HD has been reported (10)(11)(12)(13).…”

“…Pathophysiological mechanisms causing fever in patients with HD and other lymphoma remain obscure, though recent progress has been made in the characterization of endogenous pyrogens produced by phagocytic cells after exposure to microbial or inflammatory agents (9). The efficiency of the antipyretic drug indomethacin (IM) has been studied in various lymphoproliferative diseases (10,11). IM has also been observed to control fever in a number of patients with visceral cancers, and may act via its suppression of prostaglandin synthesis (4, 6).…”

Neoplastic fever: a neglected paraneoplastic syndrome

“…Indomethacin, ibuprofen, diclofenac, and other nonsteroidal anti-inflammatory drugs also have been shown to be useful in treating neoplastic fever [44,56]. Reports from a small case series suggest that rofecoxib was useful for treating neoplastic fever in patients with cancer who had contraindications to naproxen [38].…”