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Alprostadil (Prostaglandin E1)


Dose & administration
Initial dose: 0.05 to 0.1 microgram/kg/min via continuous IV infusion. Titrate to response, then decrease rate to provide the lowest dose while maintaining effect. Maximum dose: 0.4 microgram/kg/min.

Higher initial infusion rates do not produce greater effects and are associated with more adverse effects

Indications
To maintain patency of the ductus arteriosus in congenital heart diseases dependent on shunting for oxygenation

Contraindications and special considerations (incl incompatibilities)
There are no known contraindications or incompatibilities.

Adverse effects
Apnea is experienced by 10-12% of infants with congenital heart defects treated with alprostadil, especially those weighing <2 kg at birth. Apnea usually occurs during the first hour of infusion. Respiratory status should be monitored during treatment. Staff trained in resuscitation and intubation should be available.

Other common side-effects: fever, seizures, flushing, bradycardia, hypotension, tachycardia, leukocytosis, diarrhea, hypokalemia

Uncommon side-effects (<1%): respiratory distress, wheezing, hyperbilirubinemia, anemia, bleeding, thrombocytopenia, hematuria

Pharmacological aspects
Alprostadil, or prostaglandin E1, causes vasodilation, inhibits platelet aggregation, and stimulates intestinal and uterine smooth muscle.

As much as 80% may be metabolized in the first pass of the lungs.

Metabolites are excreted via the kidneys within 24 hours.

The half-life is <1 minute, thus necessitating a continuous infusion.

References

  • Arav-Boger R, Baggett HC, Spevak PJ, Willoughby RE: Leukocytosis caused by prostaglandin E1 in neonates. J Pediatr 2001;138:263-265. PMID 11174627
  • Browning Carmo KA, Barr P, West M, et al: Transporting Newborn Infants With Suspected Duct Dependent Congenital Heart Disease on Low-Dose Prostaglandin E1 Without Routine Mechanical Ventilation. Arch Dis Child Fetal Neonatal Ed 2007;92(2):F117-9. PMID 16905574
  • Cawello W, Schweer H, Muller R, et al: Metabolism and pharmacokinetics of prostaglandin E1 administered by intravenous infusion in human subjects. Eur J Clin Pharmacol 1994;46:275-7. PMID 8070511
  • Prostin VR Pediatric [package insert]. New York, NY: Pharmacia and Upjohn Company; 2013.
  • Talosi G, Katona M, Turi S: Side-effects of long-term prostaglandin E1 treatment in neonates. Pediatr Int 2007;49:335-340. PMID 17532831

Document version history
Created 2016-11-10 / Maegan Wells


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