alprostadil (Prostaglandin E1)
Indication
- temporarily maintenance of patency of ductus arteriosus in neonates with suspected or confirmed ductal-dependent congenital heart disease until corrective surgery can be performed
- Alprostadil may be considered as a therapeutic agent in refractory pulmonary hypertension with right sided heart failure under echocardiographic guidance
Dosage Guidelines
- Initial infusion rate of 0.05 mcg/kg/min. Adjust dose slowly with titration against pO2
- Once therapeutic response is achieved, titrate to the lowest effective dosage. Echocardiography may be needed to assess ductal re-opening
- Usual maintenance 0.01-0.1 mcg/kg/min
Administration
- IV continuous infusion
- The preferable route is by infusion into a large vein
- Prime all tubing prior to infusing
To prepare a 50 mL syringe of a 5 mcg/mL solution (for all weights)
- Draw up 0.5 mL (250 mcg) of the 500 mcg/mL injection
- Add to 49.5 mL of D5W or NS
Adverse Effects
- Most frequent are flushing, bradycardia, hypotension, edema and fever
- Apnea requiring ventilation may occur at higher doses or more commonly in patients weighing less than 2,000 g
- Diarrhea, bleeding
- Reversible cortical proliferation of long bones with long-term, low-dose administration
Comments
- Use with caution in infants with respiratory distress syndrome, apnea or bleeding tendencies
- Half-life ranges between 30 seconds to 10 minutes, therefore IV must be restarted immediately if interstitial
- Arterial pressure should be monitored; if it falls significantly the infusion rate should be decreased immediately
- Response in pO2 is seen approximately 30 minutes after infusion begins
Supplied As
500 mcg/mL; 1 mL ampoule (Refrigerated, accessed through Pyxis™ machine)
5 mcg/mL IV syringe (250 mcg in 50 mL solution) prepared by Pharmacy
At LHSC, standard concentration reference charts are available on the NICU Intranet site
References
Lexi Sick Kids, Lexi Peds, Neofax