alprostadil

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)

  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