Prostaglandin E1(PGE₁)

Indications

• To increase pulmonary blood flow with pulmonary atresia, 
  tricuspid atresia or critical pulmoriic stenosis in neonates. 
• To increase systemic blood flow with coarctation of aorta, 
  hypoplastic left heart and interruption of aortic arch in neonates. 
• For babies with congenital transposition of great arteries in 
  neonates. 
• For improving the left ventricular volumes by keeping the duct open in neonates.
• For treatment in severe heart failure. 
• Treatment of POAD.

Alprostadil "Pint" Dosage and Administration 
The preferred route of administration for Alprostadil "Pint" is continuous intravenous infusion into a large vein. Alternatively, Alprostadil "Pint" may be administered through an umbilical artery catheter placed at the ductal opening. Increase in blood pO₂ have been the same in neonates who received the drug by either route of administration. 

A starting dose of 0.1 micrograms per kilogram of body weight per minute is the recommended starting dose based on clinical studies: however, adequate clinical response has been reported using a starting dose of 0.05 micrograms per kilogram of body weight per minute. After a therapeutic response is achieved (increase pO₂ in infants with restricted pulmonary blood flow or increased systemic blood pressure and blood pH in infants with restricted systemic blood flow) reduce the infusion rate to provide the lowest possible dosage that maintains the response. This may be accomplished by reducing the dosage from 0.1 to 0.05 to 0.025 to 0.01 micrograms per kilogram of body weight per minute. If response to 0.05 micrograms per kilogram of body weight per minute is "inadequate dosage" can be increased up to 0.4 micrograms per kilogram of body weight per minute although, in general, higher infusion rates do not produce greater effects. 

Dilution Instructions
To prepare infusion solutions, dilute 1ml of Alprostadil "Pint" with Sodium Chloride inj. USP or Dextrose inj. USP Undiluted Alprostadil "Pint" may interact with the plastic sidewalls of volumetric infusion chambers causing a change in the appearance of the chambers and creating a hazy solution. Should this occur, the solution and the volumetric infusion chamber should be replaced. Dilute to volumes appropriate for the pump delivery system available. Prepare fresh infusion solution every 24 hours. Discard any solution more than 24 hours old.

Precautions
Because Alprostadil "Pint" inhibits platelet aggregation, use Alprostadil "Pint" cautiously in neonates with bleeding tendencies. Alprostadil "Pint" should not be used in neonates with respiratory distress syndrome. 

Necessary Monitoring
In all neonates, arterial pressure should be monitored intermittently by umbilical artery catheter, ausculation, or with a Doppler transducer. Should arterial pressure fall significantly, decrease the rate of infusion immediately.

Apnoea is experienced by about 10 to 12% of neonates with congenital heart defects treated with Alprostadil "Pint" Apnoea is most often seen in neonates weighing less than 2 kg at birth and usually appears during the first hours of drug infusion. Therefore, respiratory status should be monitored throughout treatment, and Alprostadil "Pint" should be used where ventilatory assistance is immediately available. 

Storage
Store at a temperature between 2⁰C and 8⁰C. Protect from light. 

Presentation
Each Box contains : 
1) 1 Ampoule of 1 ml. Containing 500mcg, Prostaglandin E1 (PGE₁)
2) 5 Ampoule of 1 ml. Containing 500mcg, Prostaglandin E1 (PGE₁)

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