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 (