Psychotic Reaction Associated with Postpartum Use of Indomethacin

Abstract

INTRODUCTION

Indomethacin, like other nonsteroidal anti-inflammatory drugs, exhibits anti-inflammatory, analgesic, and antipyretic properties and is therefore used to treat acute and chronic pain. The mechanism by which nonsteroidal anti-inflammatory drugs produce these effects is not fully understood; however, it is believed to be related to the inhibition of cyclooxygenase, an enzyme that catalyzes the formation of prostaglandins.1 Prostaglandins (for example, bradykinin) are thought to sensitize pain receptors to mechanical or chemical stimulation. 1 In gynecologic and obstetric applications, nonsteroidal anti-inflammatory drugs are useful for treating various pain syndromes thought to result from an increase in serum prostaglandins, such as dysmenorrhea, uterine contractions, and premenstrual physical complaints (back and muscle aches, headache, breast tenderness, and gastrointestinal discomfort). Thirty to sixty percent of patients receiving indomethacin report adverse effects, most involving the central nervous and gastrointestinal systems.1 This report describes a psychotic reaction in a patient who received an indomethacin suppository postpartum.