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NSAIDs (such as indomethacin) and calcium channel blockers (such as nifedipine) are the most likely to delay delivery for 48 hours, with the least amount of maternal and neonatal side effects. [46] Otherwise, tocolysis is rarely successful beyond 24 to 48 hours because current medications do not alter the fundamentals of labor activation. [47]
Regarding adverse effects, selective COX-2 inhibitors have lower risk of gastrointestinal bleeding. [153] With the exception of naproxen, nonselective NSAIDs increase the risk of having a heart attack. [153] Some data also supports that the partially selective nabumetone is less likely to cause gastrointestinal events. [153]
Long-term use of NSAIDs can cause gastric erosions, which can become stomach ulcers and in extreme cases can cause severe haemorrhage, resulting in death. The risk of death as a result of GI bleeding caused by the use of NSAIDs is 1 in 12,000 for adults aged 16–45. [5] The risk increases almost twentyfold for those over 75. [5]
One of the most common causes of increased bleeding risk is exposure to nonsteroidal anti-inflammatory drugs (NSAIDs). The prototype for these drugs is aspirin, which inhibits the production of thromboxane. NSAIDs (for example Ibuprofen) inhibit the activation of platelets, and thereby increase the risk of bleeding. The effect of aspirin is ...
Severe side effects include an increased risk of heart disease, stroke, gastrointestinal bleeding, and stomach ulcers. [8] The heart disease risk may be lower than with other NSAIDs. [8] It is not recommended in people with kidney problems. [8] Use is not recommended in the third trimester of pregnancy. [8] Naproxen is a nonselective COX ...
Thus indometacin users have an elevated risk of lithium toxicity. For patients taking lithium (e.g. for treatment of depression or bipolar disorder), less toxic NSAIDs such as sulindac or aspirin are preferred. All NSAIDs, including indometacin, also increase plasma renin activity and aldosterone levels, and increase sodium and potassium retention.
It’s worth noting that some people may not be candidates for epidural, such as those with bleeding or clotting disorders, certain types of brain or spine disorders or very low blood pressure.
As with other NSAIDs, potential side effects include gastrointestinal bleeding. [10] Long-term use has been associated with kidney failure, and rarely liver failure, and it can exacerbate the condition of patients with heart failure. [8] At low doses, it does not appear to increase the risk of heart attack; however, at higher doses it may. [10]