Prostaglandin E1

General

  • Type: smooth muscle relaxer, vasodilator
  • Dosage Forms:
  • Common Trade Names: Alprostadil; Prostin VR

Adult Dosing

Pediatric Dosing[1]

  • Start infusion at 0.05 mcg/kg/min IV
    • Titrate to 0.1 mcg/kg/min as tolerated, monitoring for hypotension (and apnea)

Special Populations

  • Pregnancy Rating: C
  • Lactation: infant risk cannot be ruled out
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug

Adverse Reactions

  • Beware of three common side effects that may require further resuscitation[2][3]:
    • Apnea (12%), which requires respiratory monitoring with ETCO2 capnography, potential mechanical ventilation, and/or ALS/PALS transport if needing transfer to higher level of care
    • Peripheral flushing with or without hypotension (10%), which requires fluid resuscitation
    • Fever (14%)
  • Others:

Pharmacology

  • Half-life: 5-10m
  • Metabolism: Lung
  • Excretion: Renal
  • Mechanism of Action: synthetic of endogenous prostaglandin

Comments

  • Cyanotic neonates with ductal-dependent lesions typically respond within 10-15 minutes, but may not show response until several hours after the start of infusion.

See Also

References

  1. Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC Sr, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing.Circulation. 2014 May 27;129(21):2183-242. doi: 10.1161/01.cir.0000437597.44550.5d. Epub 2014 Apr 24.
  2. Martin RJ et al. Pathophysiologic Mechanisms Underlying Apnea of Prematurity. NeoReviews Vol.3 No.4 April 2002.
  3. Segar JL. Protocol for Use of Prostaglandin E. University of Iowa Stead Family Children's Hospital. Accessed Dec 2016. https://uichildrens.org/health-library/protocol-use-prostaglandin-e?id=234424