Download ALPROSTADIL (PROSTAGLANDIN E 1 OR PGE 1)

ROYAL HOSPITAL FOR WOMEN
Approved by Neonatal Clinical Committee
CLINICAL POLICIES AND PROCEDURES
NEWBORN USE ONLY
GIVEN ON DOCTORS ORDER ONLY
ALPROSTADIL
(PROSTAGLANDIN E 1 OR PGE 1)
DESCRIPTION
Vasodilation of all arterioles and inhibition of platelet aggregation. The
smooth muscle of the ductus arteriosus is especially sensitive to its effects,
responding with marked dilatation. Maximal improvement in PaO² within 30
minutes in cyanotic lesions, and several hours in acyanotic lesions.
Response decreases after 96 hours of infusion.
USE
Maintaining the patency of Ductus Arteriosus in ductus dependent cyanotic
congenital heart disease.
PRESENTATION
500mcg/ml ampoule (1mcg=1000nanogram)
DOSE
Starting dose 5–10nanogram/kg/minute. Dose can be as high as
100nanogram/kg/min, but be prepared for intubation at bigger dose and ask
cardiologist before prescribing over 10nanogram/kg/min.
Infusion strength
1ml/hr=10 nanogram/kg/min
Prescribed amount
30mcg/kg Alprostadil to make a 50ml solution
RECONSTITUTION
Add 1 ampoule (500mcg) to 49ml of 5%dextrose or 0.9%sodium chloride to
yield a 10mcg/ml solution.
FURTHER DILUTE the prescribed amount of PGE1 with 5%dextrose or
0.9%sodium chloride to make a total of 50ml that make the dose of
1ml/hr=10nanogram/kg/min.
ROUTE
IV infusion only
ADMINISTRATION
Continuous IV infusion via dedicated cannula. Ideally use a preductal
IVcannula site (right arm or scalp vein). Infusion solution stable for 24
hours only, therefore change syringe and tubing daily.
ENSURE STEADY INFUSION RATE DELIVERY TO AVOID BOLUS ADMINISTRATION.
STORAGE
Should be stored in a refrigerator. Discard unused portion.
MONITORING
Ensure ventilated bed is available prior to commencing infusion. Closely
monitor respiratory and cardiovascular status. Assess for improvement in
oxygenation. Ensure reliable IV access. Extravasation may cause tissue
sloughing and necrosis. Monitor body temperature.
Blood pressure MUST be recorded hourly for 4 hours then 6 – 8 hourly
with cares while drug is in use. Blood pressure MUST BE CHECKED
when any change in dosage
ROYAL HOSPITAL FOR WOMEN
Approved by Neonatal Clinical Committee
CLINICAL POLICIES AND PROCEDURES
NEWBORN USE ONLY
GIVEN ON DOCTORS ORDER ONLY
ALPROSTADIL (PROSTAGLANDIN E 1 OR PGE 1) cont
ADVERSE EFFECT
Common (6%-15%) Apnoea, fever, cutaneous flushing, and bradycardia.
Gastric outlet obstruction and reversible cortical proliferation of long
bones after prolonged treatment (>120 hours).
Uncommon (1%-5%) Seizures, hypoventilation, hypotension, tachycardia,
cardiac arrest, edema, sepsis, diarrhea and disseminated
intravascular coagulopathy.
Rare (<1%) Bronchospasm,
hemorrhage,
hypoglycemia
and
hypocalcemia.
SOLUTION COMPATABILITY 5%dextrose, 0.9%sodium chloride
TERMINAL INJECTION SITE COMPATIBILITY aminophylline, atropine, calcium chloride, cefazolin,
cimetidine, clindamycin, dexamethasone, digoxin, dopamine, epinephrine,
frusemide, gentamicin, heparin, hydralazine, hydrocortisone, lidocaine,
metoclopramide, metronidazole, midazolam, morphine, nitroglycerine,
nitroprusside, pancuronium, phenobarbital, potassium chloride, penicillin G
and ranitidine.
REFERENCE
Young TE, Mangum B: Neofax: A Manual of Drugs used in Neonatal Care, ed 14. Raleigh, North Carolina: Acorn Publishing,
USA, 2001, p110-1.
Lewis AB et al. Side effects of therapy with prostaglandin E1 in infants with congenital heart disease. Circulation 1981;64:893.
Neonatal Formulary 5, Drug use in Pregnancy and First Year of Life, 2007, Blackwell Publishing Ltd