Indomethacin--a review of its role in the management of traumatic brain injury.

OBJECTIVE: To review the use of indomethacin in the management of traumatic brain injury. DATA SOURCES: Articles reported from 1966 to 2001 and identified through a MEDLINE search of the English language literature on the use of indomethacin in traumatic brain injury. SUMMARY OF REVIEW: Traumatic brain injury (TBI) is a frequent cause of mortality and morbidity in patients with head injury. The use of indomethacin in treating raised intracranial pressure (ICP) secondary to TBI is controversial. Clinical studies suggest that it may be useful in the management of intracranial hypertension, when used in combination with standard techniques, by decreasing cerebral blood flow and reducing ICP during the restoration of the blood brain barrier. Its unique mechanism of action may be due to precapillary vasoconstriction, which reduces the transcapillary transfer of fluid into the cerebral extracellular space. However, large, prospective, randomised and controlled studies have not yet been performed to confirm its benefit in patients with TBI.
CONCLUSIONS: Indomethacin should only be considered as an experimental therapy for refractory intracranial hypertension in TBI patients, as current evidence is not available to support its routine use in the management of an elevated ICP. Its use in patients with cerebral vasospasm, renal failure, bleeding disorders, peptic ulceration and coagulopathies is contraindicated.