NAME OF DRUG
alprostadil

CLASSIFICATION

Prostaglandin-vasodilator

ALTERNATE NAME

PROSTIN VR, prostaglandin E₁

INDICATIONS

• treatment of pulmonary hypertension in severe COPD or after heart transplantation (investigational)
• harvesting of heart/lung graft (investigational)
• treatment of fulminant hepatic failure and primary non-function of a transplanted liver (investigational)
• prevention of veno-occlusive disease (VOD) of the liver after allogeneic bone marrow transplantation (investigational)
• to determine if the cause of a patient’s impotence is vasculogenic in origin

RECONSTITUTION AND STABILITY

• refrigerate ampoules
• reconstituted solution is stable at room temperature for 24 hours

COMPATIBILITY

• compatible with NS and D5W

ROUTES OF ADMINISTRATION

• intracorpus cavernosum
• IV infusion
• Pulmonary hypertension - dilute 1mL (500mcg) alprostadil in 50mL D5W or NS to give a 10mcg/mL solution
• Hepatic failure/VOD - dilute 1mL (500mcg) alprostadil in 500mL D5W or NS to give a 1mcg/mL solution
• rate of administration varies; see dosage

Sonographers may administer alprostadil intracorpus cavernosum under the direct supervision of a physician and in adherence with the Radiology Departmental Policies

A - Not to be administered by the direct IV route.

H - The IV infusion rate must be controlled by an automated infusion control device.

Use is restricted to Special and Critical Care Areas with ECG monitoring except in those situations where the patient is not considered a candidate for a Special Care Area and the physician considers alprostadil essential. In these selected circumstances and after consultation with the attending physician, and head nurse or delegate, alprostadil may be administered.

DOSAGE

Treatment of Pulmonary Hypertension associated with severe COPD:

• IV infusion: 1.2-2.4 mcg/kg/hr (20 to 40 ng/kg/min)

Treatment of Pulmonary Hypertension after heart transplantation:

• IV infusion: 1.2-7.2 mcg/kg/hr (20 to 120 ng/kg/min)

Treatment of Hepatic Failure:

• initial infusion: 10mcg/hr
• infusion may be increased by 10mcg/hr to a maximum of 0.6mcg/kg/hr (10ng/kg/min)

Prevention of veno-occlusive disease:

• IV infusion: 0.3mcg/kg/hr (5ng/kg/min)

Dosage and duration of treatment is dependent on patient response

Intracorpus cavernosum: 5-10mcg (0.5-1mL of 10mcg/mL strength)

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• hypotension, diarrhea, fever, fluid retention, headache, flushing and malaise
• intracorpus cavernosum – sustained erection

IMPORTANT IMPLICATIONS

• during therapy employing doses of 1.2mcg/kg/hr or greater, cardiac and respiratory status should be continuously monitored. The infusion should be stopped and restarted at a lower dose if significant side effects occur (eg. systolic BP <100mmHg, severe diarrhea)

Revised Feb 2003