Alprostadil(al pross’ ta dil)
IV: Prostin VR Pediatric
Intracavernous: Caverject, Caverject Impulse, Edex, Muse
PREGNANCY CATEGORY (NOT APPLICABLE)
Drug Class
Prostaglandin
Therapeutic Actions
Relaxes vascular smooth muscle; the smooth muscle of the ductus arteriosus is especially sensitive to this action and will relax and stay open; this is beneficial in infants who have congenital defects that restrict pulmonary or systemic blood flow and who depend on a patent ductus arteriosus for adequate blood oxygenation and lower body perfusion. Treatment of erectile dysfunction due to neurogenic, vasculogenic, psychogenic, or mixed etiology.
Indications
Palliative therapy to temporarily maintain the patency of the ductus arteriosus until corrective or palliative surgery can be performed in neonates with congenital heart defects who depend on a patent ductus (eg, pulmonary atresia or stenosis, tetralogy of Fallot, coarctation of the aorta), men for whom sexual activity is unadvisable
Treatment of erectile dysfunction (intracavernous injection)
Unlabeled use: Raynaud’s disease
Contraindications and Cautions
Contraindicated with respiratory distress syndrome (IV), conditions that might predispose to priapism, deformation of the penis, penile implants (intracavernous injection), known hypersensitivity, urethral strictures, severe hypospadias and curvature, acute or chronic urethritis, tendency for thromboembolism (urogenital).
Use cautiously with patients with bleeding tendencies (drug inhibits platelet aggregation), hypotension, dizziness.
Available Forms
Powder for injection—10, 20, 40 mcg/mL; 10, 20 mcg/0.5 mL; injection (IV)—10, 20 mcg/mL; 40 mcg/2 mL (penile); 500 mcg/mL; pellets—125, 250, 500, 1,000 mcg
Dosages
Adults
Intracavernous injection
0.2–60 mcg by intracavernous injection using 0.5-in 27–30 gauge needle; may be repeated up to three times weekly with at least 24 hr between doses. Self-injection over 6-mo period has been successful. Reduce dose if erection lasts more than 1 hr.
Urogenital
Initially, 125–250 mcg; maximum dosage, 2 systems per 24 hr.
Pellet
125, 250, 500, or 1,000 mcg based on patient response. Maximum dosage, two systems in 24 hr administered intraurethrally.
Pediatric patients
Preferred administration is through a continuous IV infusion into a large vein; may be administered through an umbilical artery catheter placed at the ductal opening. Begin infusion with 0.05–0.1 mcg/kg/min. After an increase in partial pressure of oxygen (pO2) or in systemic BP and blood pH is achieved, reduce infusion to the lowest possible dosage that maintains the response (often achieved by reducing dosage from 0.1–0.05 to 0.025–0.01 mcg/kg/min). Up to 0.4 mcg/kg/min may be used for maintenance if required; higher dosage rates are not more effective.
