alprostadil

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

alprostadil (prostaglandin E1)

Indication

  • Temporary 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)

  1. Draw up 0.5 mL (250 mcg) of the 500 mcg/mL injection
  2. 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