<scp>CNS</scp> effects of indomethacin: should patients be cautioned about decreased mental alertness and motor coordination?

The use of medicinal plants in the management of diverse ailments is entrenched in the culture of indigenous people in African communities. This review provides a critical appraisal of the ethnobotanical uses of medicinal plants for the management of headache in Africa. Research articles published from 2010 (Jan) to 2021 (July) with keywords such as Africa, ethnobotany, headache, medicinal plant and traditional medicine were assessed for eligibility based on sets of pre-defined criteria. A total of 117 plants, representing 56 families, were documented from the 87 eligible studies. Asteraceae (10%), Fabaceae (10%), Lamiaceae (9%) and Mimosaceae (5%) were the most represented plant families. The most popular plant species used in the management of headache were Ocimum gratissimum L. (n = 7), Allium sativum L. (n = 3), Ricinus communis L. (n = 3) and Artemisia afra Jack. ex. Wild (n = 2). The leaves (49%), roots (20%) and bark (12%) were the most common plant parts used. Decoction (40%) and infusion (16%) were the preferred methods of preparation, whereas the oral route (52%) was the most preferred route of administration. The data revealed that medicinal plants continue to play vital roles in the management of headache in African communities. In an attempt to fully explore the benefits from the therapeutic potential of indigenous flora for common ailments, further studies are essential to generate empirical evidence on their efficacies, using appropriate test systems/models. This approach may assist with the ongoing drive towards the integration of African traditional medicine within mainstream healthcare systems.

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“…Stomach or gut irritation, indigestion and nausea [18]. Gastric ulcerations, allergic reactions [19].…”

Section: Anti-inflammatory Antipyretic and Analgesicmentioning

confidence: 99%

A Review on Medicinal Plants Used in the Management of Headache in Africa

Frimpong

Asong

Aremu

2021

Plants

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“…In general the adverse neurologic effects associated with NSAID therapy are thought to be related to inhibition of prostaglandin synthesis. Dizziness, headaches, drowsiness, and confusion are the most commonly encountered adverse neurologic effects with NSAID use [ 81 ]. Indometacin therapy in particular is associated with an increased risk of neurologic adverse effects.…”

Section: Considerations When Using Asa or Nsaids For The Treatmentmentioning

confidence: 99%

Non-Steroidal Anti-Inflammatory Drugs and Aspirin Therapy for the Treatment of Acute and Recurrent Idiopathic Pericarditis

Schwier

Tran

2016

Pharmaceuticals

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Aspirin (ASA) and non-steroidal anti-inflammatory drugs (NSAIDs) are a mainstay of therapy for the treatment of idiopathic pericarditis (IP). A comprehensive review consisting of pertinent clinical literature, pharmacokinetic, and pharmacodynamic considerations, has not been released in recent years. This review will facilitate the clinician’s understanding of pharmacotherapeutic considerations for using ASA/NSAIDs to treat IP. Data were compiled using clinical literature consisting of case reports, cohort data, retrospective and prospective studies, and manufacturer package inserts. ASA, ibuprofen, indometacin, and ketorolac relatively have the most evidence in the treatment of IP, provide symptomatic relief of IP, and should be tapered accordingly. ASA is the drug of choice in patients with coronary artery disease (CAD), heart failure (HF), or renal disease, but should be avoided in patients with asthma and nasal polyps, who are naïve to ASA therapy. Ibuprofen is an inexpensive and relatively accessible option in patients who do not have concomitant CAD, HF, or renal disease. Indometacin is not available over-the-counter in the USA, and has a relatively higher incidence of central nervous system (CNS) adverse effects. Ketorolac is an intravenous option; however, clinicians must be mindful of the maximum dose that can be administered. While ASA/NSAIDs do not ameliorate the disease process of IP, they are part of first-line therapy (along with colchicine), for preventing recurrence of IP. ASA/NSAID choice should be dictated by comorbid conditions, tolerability, and adverse effects. Additionally, the clinician should be mindful of considerations such as tapering, high-sensitivity CRP monitoring, bleeding risk, and contraindications to ASA/NSAID therapy.

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“…9 Central nervous system adverse effects, such as dizziness and drowsiness, are also commonly reported. 10…”

mentioning

confidence: 99%

Etoricoxib and celecoxib sensitive indomethacin‐responsive headache disorders

Farag

Bahra

2022

Headache

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Indomethacin-responsive headaches include paroxysmal hemicrania (PH) and hemicrania continua (HC), two of the disorders within the group termed the trigeminal autonomic cephalalgias, and other primary headache disorders, such as primary stabbing headache (PSH), primary cough headache (PCH), and primary headache associated with sexual activity (PHASA). These headache syndromes differ in clinical features and extent of response to indomethacin. 1 In the current International Classification of Headache Disorders, 3rd edition 2 an absolute response to indomethacin is mandatory to diagnose PH and HC. Although not a diagnostic criterion for PCH, PHASA, or PSH, indomethacin is the most consistently reported preventative effective for these paroxysmal and usually short-lived headaches. 1,3,4 Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that acts as a reversible inhibitor of prostaglandin-forming cyclooxygenase (COX), inhibiting COX-1 and COX-2 isoforms, with greater selectivity for the former. 5 The drug has been demonstrated to penetrate the blood-brain barrier in vivo using rat brain perfusion technique, thus rendering indomethacin able to target mechanisms within the central nervous system. 6 A potential nitrergic mechanism of action for indomethacin has been postulated given that indomethacin has been demonstrated to inhibit nitric oxideinduced dural vasodilation using the in vivo technique of intravital microscopy in rats. 7 Indomethacin may thus have a role in modulating cerebral vasodilatory prostaglandin production, although the defined mechanism of action relevant to indomethacin-responsive headaches is yet to be elucidated.Most patients show a rapid therapeutic response to indomethacin but, despite concomitant gastroprotection, intolerability limits its use. Unfortunately, there remain limited satisfactory alternatives. 1,8 Gastrointestinal adverse effects are the main complications ranging from dyspepsia to life-threatening gastrointestinal bleeding.Other adverse effects include effects on blood pressure, cardiovascular, hepatic and renal dysfunction, and platelet inhibition. 9 Central nervous system adverse effects, such as dizziness and drowsiness, are also commonly reported. 10

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CNS effects of indomethacin: should patients be cautioned about decreased mental alertness and motor coordination?

Cited by 5 publications

References 25 publications

A Review on Medicinal Plants Used in the Management of Headache in Africa

A Review on Medicinal Plants Used in the Management of Headache in Africa

Non-Steroidal Anti-Inflammatory Drugs and Aspirin Therapy for the Treatment of Acute and Recurrent Idiopathic Pericarditis

Etoricoxib and celecoxib sensitive indomethacin‐responsive headache disorders

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