PROSTAGLANDIN E1 (ALPROSTADIL)
Paediatric Prostin VR
Reviewed by Dr Jon Skinner, Brenda Hughes, Cherry Olson, Jo Tatler and Rob Ticehurst
Management of Prostaglandin Administration
- Clear solution 500 micrograms/mL (in dehydrated alcohol) in 1mL ampoules.
- Osmolality at 2 micrograms/mL approx. 340mOsm/kg; and at 20 micrograms/mL 925mOsm/kg.4
- maximum stability for postaglandin at pH = 3
Charted on fluid chart giving:
- rate in ml/hour
- dose in nanograms/kg/minute
Also charted on drug chart under
continuous infusions giving:
- amount of drug to be added
- base fluid, type and volume
- concentration in micrograms/mL
- To prepare a solution of 125 micrograms/ml:
- Add 125 micrograms (0.25ml) of Prostaglandin E1 to 0.75ml 0.9% NaCl
- Calculate charted dose of Prostaglandin E1 and make up to 50 ml with 0.9% NaCl,
Dextrose 5%, or Dextrose 10%.
- 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.
- Administered by a nurse with Neonatal IV Drug Certification or infant cardiac unit experience.
- Dilute as prescribed to 3 - 6micrograms/ml. Maximum concentration = 20micrograms/ml. Mix well.
- 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.
- Administer into a large vein.
- Must be given by continuous IV infusion via a syringe
pump because of the rapid metabolism of this drug.
- Compatible with Normal Saline, Dextrose 5%, Dextrose 10%.
- Maintain a patent IV line at all times.
- Change solution and tubing every 24 hours.
Observation and Documentation
- Monitor for adverse reactions, especially decreased
respiratory effort, periodic breathing or apnoea.
- Ensure reliable I.V. access, observe closely for IV
infiltration and resite immediately if this occurs.
- Closely monitor heart rate, respirations, and temperature. Document
hourly. 10 –12 % of babies will have apnoea.
- Assess the duct for patency
- Monitor oxygenation with blood gases and pulse
- 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.
- Neonates receiving more than 120 hours of PGE1 should be monitored for
evidence of antral hyperplasia and gastric outlet obstruction.
- Store in refrigerator at 2°-8°C.
- Discard ampoule after use.
- Diluted solution stable for 24 hours at room temperature.
Heymann MA. Pharmacologic use of Prostaglandin E1 in infants with
congenital heart disease. Am Heart J 1981; 101:837.
Lewis AB, Fried MD, Heymann MA, et al. Side effects of therapy with
Prostaglandin E1 in infants with congenital heart disease. Circulation
Prostin VR data sheet.Auckland: Pfizer,
2005. On-line version:pfdprosil11105;MOH Approved: 25 January 2006.
Owen D (personal communication). Pharmacia; Jan 4, 2001.
Boyd, Caroline (Phone communication). Obex Medical; April 3, 2001.
Trissel,L.Handbook of Injectable Drugs(15th
ed.). Bethesda:American Society of Health-Systems Pharmacists,2009.