PROSTAGLANDIN E1 (ALPROSTADIL)

Paediatric Prostin VR

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

 

Management of  Prostaglandin Administration

Description

Prescription

Charted on fluid chart giving:

Also charted on drug chart under continuous infusions giving:

Administration

Continuous Infusion

  1. To prepare a solution of 125 micrograms/ml:
    1. Add 125 micrograms (0.25ml) of Prostaglandin E1 to 0.75ml 0.9% NaCl
    2. Calculate charted dose of Prostaglandin E1 and make up to 50 ml with 0.9% NaCl, Dextrose 5%, or Dextrose 10%.
  2. Y-site compatible with caffeine citrate, dopamine, heparin, and morphine.  Do NOT mix with blood or blood product. Recommended to use a separate line for alprostadil (Prostaglandin E1) administration. Do NOT flush line.
  3. Administered by a nurse with Neonatal IV Drug Certification or infant cardiac unit experience.
  4. Dilute as prescribed to 3 - 6micrograms/ml. Maximum concentration = 20micrograms/ml. Mix well.
  5. Filter prior to administration through a 5 micron filter needle. Do NOT use a PALL 0.2 micron filter as the air filter may be destroyed by the alcohol content. 5
  6. Administer into a large vein.
  7. Must be given by continuous IV infusion via a syringe pump because of the rapid metabolism of this drug.
  8. Compatible with Normal Saline, Dextrose 5%, Dextrose 10%.
  9. Maintain a patent IV line at all times.
  10. Change solution and tubing every 24 hours.

Observation and Documentation

  1. Monitor for adverse reactions, especially decreased respiratory effort, periodic breathing or apnoea.
  2. Ensure reliable I.V. access, observe closely for IV infiltration and resite immediately if this occurs.
  3. Closely monitor heart rate, respirations, and temperature. Document hourly. 10 –12 % of babies will have apnoea.
  4. Assess the duct for patency
  5. Monitor oxygenation with blood gases and pulse oximetry.
  6. Assess for signs of improvement eg. increased blood oxygenation with cyanotic heart disease; and improved blood pressure, blood pH, and urine output for acyanotic heart disease.
  7. Neonates receiving more than 120 hours of PGE1 should be monitored for evidence of antral hyperplasia and gastric outlet obstruction.
     

Storage

Selected References

1 Heymann MA. Pharmacologic use of Prostaglandin E1 in infants with congenital heart disease. Am Heart J 1981; 101:837.
2 Lewis AB, Fried MD, Heymann MA, et al. Side effects of therapy with Prostaglandin E1 in infants with congenital heart disease. Circulation 1981; 64:893.
3 Prostin VR data sheet.Auckland: Pfizer, 2005. On-line version:pfdprosil11105;MOH Approved: 25 January 2006.
4 Owen D (personal communication).  Pharmacia; Jan 4, 2001.
5 Boyd, Caroline (Phone communication).  Obex Medical; April 3, 2001.
6 Trissel,L.Handbook of Injectable Drugs(15th ed.). Bethesda:American Society of Health-Systems Pharmacists,2009.