A prospective randomized study of the effectiveness and the side effects of ibuprofen and indomethacin in the treatment of PDA observed a marked influence of indomethacin on serum creatinine. It is sold under the brand names Bonine, Bonamine, Antivert, Postafen, Sea Legs, and Dramamine II (Less Drowsy Formulation). The tocolytic action and side effects of the other four agents is schematically shown in A new tocolytic agent that is being investigated in the management of premature labor is nitric oxide. Reduction of urinary volume and glomerular filtrate are usually reversible within 48 hours by discontinuation of therapy, whereas oliguria may persist for 2 weeks. Moreover, interstitial nephritis due to an immunologic reaction could also be responsible for NSAID-associated ARF in children (even if relatively uncommon).Although the risk of developing ARF is small in healthy young patients, the absolute number of children who may develop ARF is large because the drugs are widely used. Interpreting the efficacy of tocolytic agents in preterm labor trials is difficult due to the heterogenous definitions used to describe success. Through blockage of prostaglandin synthesis with inhibition of cyclooxygenase (COX) enzymes, these drugs may provoke renal damage that may result in ARF with or without oliguria, chronic renal failure, significant proteinuria, fluid metabolism alterations, and hyperkalemia. Moreover, NSAIDs are frequently used in children because of their antipyretic activity—as well as their analgesic and antiinflammatory properties.The nephrotoxic effects of NSAIDs are related to their mechanism of action. In a recent study, the use of glyceryl trinitrate (a nitric oxide donor) patches applied to the abdomen of 13 women in premature labor at 23–33 weeks gestation, inhibited uterine contractions and prolonged pregnancy by an average of 34 days. β₂-Sympathomimetic agent. It was initially hoped that COX-2 inhibitors such as celecoxib and rofecoxib would be less nephrotoxic than conventional NSAIDs, but this has not been confirmed.Magnesium sulfate was until recently the most frequently used tocolytic agent for treatment of preterm labor.Magnesium sulfate has been used for many years in obstetrics as a tocolytic agent for preterm labor and as therapy for preeclampsia. The proposed tocolytic agent contains as an active component a tetrahydroisoquinoline derivative of the general formula (I) in which R1 = OH, H, R2 = R3 = OH, H, R4 = OH, H in a mixture with pharmaceutical auxiliary materials. Meclizine is an international nonproprietary name. The onset of labor in animals is associated with decreased nitric oxide synthesis in the uterus. Tocolytic agent. Different agents of tocolytics are prescribed by doctors after assessing the risks and the benefits. Critical analyses have demonstrated that most tocolytics are effective for prolongation of pregnancy for only 48–72 hours (Tocolytic drugs are usually given to prolong gestation during the preterm period. For other uses, see InChI=1S/C25H27ClN2/c1-20-6-5-7-21(18-20)19-27-14-16-28(17-15-27)25(22-8-3-2-4-9-22)23-10-12-24(26)13-11-23/h2-13,18,25H,14-17,19H2,1H3"[C]atalepsy was assessed by the bar method[:] the front paws were gently placed on a horizontal metal bar with 2 mm diameter suspended 4 cm above, and the length of time the mouse maintains this abnormal posture was measured." Some doctors prescribe tocolytics post completion of 34 weeks of pregnancy while others wait till the 36th week. Users are advised not to operate heavy machinery while under the influence. Instead, data from recent studies have shown transient severe oliguria and even permanent renal failure after nimesulide exposure in utero.For many years, indomethacin has been the drug of choice in the treatment and prophylaxis of PDA in premature neonates. Among its side effects, transient or permanent alterations in renal function have been frequently reported. The tocolytic agent that is most effective and has the least side effects is selected individually for each patient.

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