Generic Name:

Prostaglandin E- 1 (PGE 1), Intravenous

Trade Name:

Alprostadil

Designated Clinical Areas:

E llison 11, Ellison 10, Bigelow 14

Action:

Potent vasodilator and inhibitor of platelet aggregation

Indication:

Distal ischemia (limb or digitit) refractory to conventional revascularization or drug therapy.

Vasospastic disorders (Raynaud's), vasculitis, Buerger's, atheroembolic diseases

Administrative Guidelines:

Usual dose and route:

Intravenous administration

Pre-infusion:

Notify unit-based Pharmacist ASAP to facilitate timely medication preparation

Obtain following labs before initiating drug infusion: Lytes, BUN, Cr, CBC, LFTs, BP, HR

Infusion:

Start the infusion at 1 NANOGRAM/Kg/Min
The infusion rate (dose) may be doubled every 30 minutes as tolerated to a peak dose of 16 NANOGRAMS/Kg/Min. A starting dose of 0.4 ng/kg/min is recommended in patient with borderline low blood pressure and/or poor LV function.
Reassess clinical response and tolerability after every rate change and at least on a daily basis.

Weaning:

Alprostadil is a short acting vasodilator therefore weaning is recommended to prevent rebound vasoconstriction. Suggested weaning guideline:
Two hours before stopping infusion, cut infusion dose/rate by one half
One hour before stopping infusion, cut infusion dose/rate again by one half
At zero hour, discontinue infusion

Standard Concentration

500 micrograms of Alprostadil in 1000 ml NS

1000 nanograms= 1 microgram

NOTE: This concentration is not programmed in any pump library. The rate mode must be used when administering. Please contact your covering pharmacy for assistance with rate calculations.

Critical Elements/Special Considerations:

Patients must be on a centralized cardiac monitor while this drug is being infused.

BP/HR q 15 minutes after every rate change X 2, , then Q 4 hours while stable infusion running
Record peripheral pulses or Doppler signals, motor and sensory function with each set of VS
Daily weight and accurate I and O's

Dedicated minimum 20g IV catheter or larger if possible.

Consider PICC or central line if anticipated duration of infusion lengthy or poor peripheral access to accommodate

Precaution and Side Effects

Precautions :

Hypotension (most common dose limiting side effect)

LV dysfunction: PGE1 can cause significant fluid retention/shifts
Liver dysfunction: Alprostadil is metabolized in the liver
Known CAD/cerebrovascular disease -- a "steal syndrome" has been described when used in circumstances of proximal arterial stenosis. Recent MI/TIA/stroke
Women of childbearing age
Decompensated HF
Arrhythmia -- Frequently may cause sinus tachycardia and/or sinus bradycardia
High-degree AV block

Equipment:

Volumetric pump for IV: use in dose calculate mode or using drug library

Approved by:

Nursing Practice – June 09

MESAC – June-09

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