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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 E2 ORAL
(Dinoprostone, PROSTIN E2R)

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

  • relaxes the ductus arteriosus in early postnatal life and supports its patency
  • estimated half life of 5 to 10 minutes
  • major route of parent drug and metabolites is by the kidney
  • less effective than continuous IV infusion

Side Effects

  • APNEA
  • 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 dose should be decreased

Dose

  • prostaglandin E2 is administered orally as powders prepared by Pharmacy
  • the dose required is extremely variable and must be individualized
  • the usual dose is 30-45 mcg/kg/hour
  • it may be necessary to overlap oral and IV (prostaglandin E1) therapy, tapering the IV dose down when the patient responds to the oral dose
  • it may be necessary to start with very frequent (ie. q1-2h) administration and attempt to "wean" the baby (ie. give larger doses less frequently)

Supplied

  • 0.5 mg tablets or powders of various strengths prepared by Pharmacy
  • tablets and powders must be REFRIGERATED - this drug is very sensitive to temperature



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