PROSTAGLANDIN E1 (ALPROSTADIL)
Paediatric Prostin VR
|Reviewed by Dr Jon
Skinner, Brenda Hughes, Cherry Olson, Jo Tatler and Rob Ticehurst
5 to 100 nanograms/kg/minute
(0.005-0.1 micrograms/kg/minute) by continuous intravenous infusion.
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.
Maintenance dose may be as low
as 5 nanograms/kg/minute (0.005 micrograms/kg/minute).
Prostaglandin (micrograms) in 50ml IV solution =
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.
Dilatation of ductus arteriosus in infants with ductal dependent congenital heart defects:
- Transposition of the great vessels.
- All right sided cyanotic congenital heart defects associated with reduced pulmonary perfusion.
- Left sided congenital heart defects including hypoplastic left heart syndrome, coarctation of aorta and
interrupted aortic arch.
- Respiratory distress. Alprostadil (Prostaglandin E1) should not
be used in neonates with Respiratory Distress.3
- Total anomalous venous return with obstruction.
- Infants with bleeding tendencies (Alprostadil inhibits platelet aggregation).
- Seizure disorders.
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.
Maximal drug effect usually seen within 30 minutes in cyanotic lesion: may take
several hours in acyanotic lesions.
Possible Adverse Effects 3
- Hyperthermia (transient).
- Skin flush secondary to vasodilation- occurs more frequently with intraarterial administration.
- Sepsis, cardiac arrest, disseminated intravascular coagulation, hypokalaemia, oedema, cortical proliferation of the long bones.
- Alprostadil (Prostaglandin E1)
is rapidly metabolised and must, therefore, always be given by continuous
intravenous infusion. Vascular access must be secure at all times and may
demand the insertion of a central venous catheter or long line to ensure
continuity of delivery.
- The maintenance dose of the
Alprostadil (Prostaglandin E1) infusion is determined by
titration according to the infant's response - oxygenation versus adverse
- Observe respiratory effort closely
- Monitor arterial pressure closely. If arterial pressure falls, a bolus
of fluid ( 10- 20 ml/kg) is required. It may be necessary to decrease
the rate of infusion.
- Pulse oximetry is mandatory due to risk of apnoea and to monitor
therapeutic effect in cyanotic heart disease.
- Where there is restricted systemic blood flow, measure efficacy by
monitoring improvement of systemic blood pressure and blood pH, and
femoral pulses/arm-leg BP gradient in aortic coarctation.
- Renal function; full Blood Count & platelets frequently.
- Increased infant temperature is not an indication to stop therapy.