PROSTAGLANDIN E1 (ALPROSTADIL)

Paediatric Prostin VR

Reviewed by Dr Jon Skinner, Brenda Hughes, Cherry Olson, Jo Tatler and Rob Ticehurst
March 2010
Administration Newborn Drug Protocol Index Newborn Services Home Page

 

Dose and Administration

  1. 5 to 100 nanograms/kg/minute (0.005-0.1 micrograms/kg/minute) by continuous intravenous infusion.
  2. Start with low infusion rate and titrate according to the infant's response. Higher initial doses are usually no more effective and have a higher incidence of adverse effects.
  3. Maintenance dose may be as low as 5 nanograms/kg/minute (0.005 micrograms/kg/minute).
Prostaglandin (micrograms) in 50ml IV solution =  3 x weight (kg) x dose (nanograms/kg/min)
                   IV rate (ml/hr)

Usual dilution 3 - 6 micrograms/ml. In rare situations the strength can be made up to 20 micrograms/ml. This is however very hyperosmolar. At 3 micrograms/ml, 1ml/hour = 0.05 micrograms/minute.

Indications

Dilatation of ductus arteriosus in infants with ductal dependent congenital heart defects:

  1. Transposition of the great vessels.
  2. All right sided cyanotic congenital heart defects associated with reduced pulmonary perfusion.
  3. Left sided congenital heart defects including hypoplastic left heart syndrome, coarctation of aorta and interrupted aortic arch.

Contraindications

  1. None. 3

Precautions

  1. Respiratory distress. Alprostadil (Prostaglandin E1) should not be used in neonates with Respiratory Distress.3
  2. Total anomalous venous return with obstruction.
  3. Infants with bleeding tendencies (Alprostadil inhibits platelet aggregation).
  4. Seizure disorders.

Clinical Pharmacology

Prostaglandin E1 is a potent vasodilator of all arterioles. Other effects include inhibition of platelet aggregation, and stimulation of uterine and intestinal small muscle. Alprostadil (Prostaglandin E1) is rapidly cleared by metabolism, primarily occurring in the lungs, and excretion via the kidney. 3 Maximal drug effect usually seen within 30 minutes in cyanotic lesion: may take several hours in acyanotic lesions.

Possible Adverse Effects 3

  1. Apnoea.
  2. Hypotension.
  3. Hyperthermia (transient).
  4. Hypoglycaemia.
  5. Tachycardia.
  6. Bradycardia.
  7. Seizures.
  8. Diarrhoea.
  9. Skin flush secondary to vasodilation- occurs more frequently with intraarterial administration.
  10. Sepsis, cardiac arrest, disseminated intravascular coagulation, hypokalaemia, oedema, cortical proliferation of the long bones.

Special Considerations