Prostaglandin E1 (Alprostadil)
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Dose and administration
- 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 = 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.
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.3 Maximal drug effect usually seen within 30 minutes in cyanotic lesion: may take several hours in acyanotic lesions.
Possible adverse effects
- Hyperthermia (transient).
- Skin flush secondary to vasodilation - occurs more frequently with intra-arterial 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 effects.
- 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.
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, Glucose 5%, or Glucose 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.5
- 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, Glucose 5%, Glucose 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 oximetry.
- 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 1981; 64:893.
- 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.
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- Date last published: 31 March 2010
- Document type: Drug Dosage Guideline
- Services responsible: ADHB Pharmacy, Neonatology
- Editor: Sarah Bellhouse
- Review frequency: 2 years