Patent ductus arteriosus closure: why same-dose oral ibuprofen is superior to intravenous

Abstract

Ibuprofen is used in neonates to treat patent ductus arteriosus (PDA). Several randomised controlled trials have compared oral ibuprofen to intravenous for closing of PDA. Surprisingly, oral administration seems more effective than same dose intravenously. This is unusual from a pharmacological perspective. In general, it is unlikely that the systemic effect of a drug will be better from oral administration than the same dose administered intravenously.\n\nA Cochrane meta-analysis including five studies in the comparison of oral versus intravenous ibuprofen found that oral administration of ibuprofen was more effective in PDA closure (risk ratio favouring oral ibuprofen 0.38 (95% CI 0.26 to 0.56)). Need for surgical closure of the ductus had similar effect size but was insignificant (risk ratio 0.41, 95% CI 0.14 to 1.21), …