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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