What is the first-line treatment for patent ductus arteriosus (PDA)?

The first-line treatment for patent ductus arteriosus (PDA) is indomethacin, a nonsteroidal anti-inflammatory drug (NSAID). Indomethacin works by inhibiting cyclooxygenase (COX) enzymes, which leads to a decrease in prostaglandin levels. Prostaglandins are important for maintaining the patency of the ductus arteriosus, so by reducing their levels, indomethacin promotes the closure of the ductus.

This pharmacological approach is particularly effective in premature infants, where the ductus arteriosus may remain patent and contribute to problems such as increased pulmonary blood flow and heart failure. Indomethacin has been shown to be effective in this context and is often the preferred treatment option due to its efficacy and relatively favorable side-effect profile.

In contrast to indomethacin, prostaglandin E1 is used clinically to maintain ductal patency in certain congenital heart conditions but is not indicated for closure of a PDA. Diuretics and beta-blockers do not target the ductus directly and are not effective in facilitating its closure.