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Disclaimer to the On-line 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.

PROSTAGLANDIN E1 IV INFUSION
(Alprostadil, PROSTIN VRR)

Indication

  • to temporarily maintain the patency of the ductus arteriosus until corrective or palliative surgery can be performed in neonates who have congenital heart defects and who depend upon a patent ductus arteriosus for survival

Pharmacology

  • prostaglandin E1 (alprostadil) relaxes the ductus arteriosus in early postnatal life and supports the patency when continuously infused IV or intra-arterially
  • estimated half life of 5 to 10 minutes
  • approximately 70% of drug is removed by pulmonary vascular bed in a single pass
  • major route of parent drug and metabolites is by the kidney

Side Effects

  • APNEA, usually within first hour of infusion in approximately 12% of neonates; most common if birth weight <2,000 g
  • cardiovascular: flushing, bradycardia, hypotension, tachycardia
  • CNS: fever, seizures
  • GI: diarrhea
  • bleeding

Contraindications

  • persistent fetal circulation

Precautions

  • use with caution in infants with a history of APNEA or bleeding disorders
  • monitor stools for occult blood
  • arterial pressure should be monitored; if it falls significantly the infusion rate should be decreased immediately

Dose

  • CONTINUOUS INFUSION at an initial rate of 0.05 mcg/kg/min. Titrate to lowest possible dose that maintains patency of duct (range 0.01 to 0.4 mcg/kg/min). Usual rate is 0.1 mcg/kg/min
  • the PREFERABLE route is by infusion into a large vein. Alternatively, alprostadil may be administered through an umbilical artery catheter placed at the ductal opening

Supplied

  • 500 mcg/mL; 1 mL ampoule
  • STORE IN REFRIGERATOR
  • dilute 1 mL Prostin(R) VR (500 mcg) in 50 mL sterile saline or sterile 5% Dextrose in Water, to provide a solution containing 500 mcg prostaglandin E1 (concentration = 10 mcg/mL)
  • prepare a fresh solution every 24 hours

References

  1. Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
  2. Zenk KE, Sills JH and Koeppel RM : Neonatal Medications and Nutrition - A Comprehensive Guide, NICU INK Book Publishers, Santa Rosa, California, 1999.




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