Alprostadil (PGE1) for Maintaining Ductal Patency

Marcia L. Buck, Pharm.D., FCCP

Pediatr Pharm. 2000;6(9)

Introduction

Alprostadil, or prostaglandin E₁ (PGE₁), can be a lifesaving drug for infants born with ductus-dependent congenital heart disease. Therapy with PGE₁ can effectively maintain an infant's cardiovascular function until palliative or corrective cardiac surgery can be performed. In many cases, this allows transport of the patient from the local institution to a tertiary care center capable of performing neonatal cardiac surgery.

It has been recommended that early medical stabilization of these infants with PGE₁ be initiated at the local hospital immediately after establishing a preliminary diagnosis and continued during transport.^{[1,2,3,4,5,6]} For this to be accomplished, it is necessary to have the drug available at most hospitals offering obstetric services. Because of the infrequent need for PGE₁ at the local level, this issue of Pediatric Pharmacotherapy is provided as a staff resource. This article will review the role of PGE₁ in maintaining systemic oxygenation, describe commonly encountered adverse effects, and provide dosing recommendations.

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Cite this: Alprostadil (PGE1) for Maintaining Ductal Patency - Medscape - Sep 01, 2000.

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Nalmefene Safety and Pharmacokinetics.

Like other opioid antagonists, nalmefene, has been used successfully in combination with opioid infusions to reduce their adverse effects. The tolerability and pharmacokinetics of nalmefene in children were evaluated in this randomized, double-blind placebo-controlled trial. Thirty-four children between the ages of 2 and 12 years received either a placebo or 1 mcg/kg intravenous bolus of nalmefene. All of the children had just undergone cardiac or thoracic surgery and were receiving epidural opioid infusions. Nalmefene pharmacokinetic parameters were similar to values previously reported in adults, including an elimination half-life of 8.7+2.3 hours and a volume of distribution of 7.21+2.49 L/kg. All patients tolerated the single dose without symptoms of opioid withdrawal. Opioid-induced adverse effects were not significantly different between the groups, which may reflect the need for higher nalmefene doses. Rosen DA, Morris JL, Rosen KR, et al. Nalmefene to prevent epidural narcotic side effects in pediatric patients: a pharmacokinetic and safety study.

Pharmacotherapy 2000;20:745-9.

Phenytoin Interaction With Enteral Feedings. In this concise review, the authors weigh the evidence supporting or refuting the significance of decreased serum phenytoin concentrations when the drug is given with enteral feedings. Twenty-nine articles are evaluated, including the only randomized, controlled trial published to date. Despite the lack of overwhelming scientific evidence, the authors acknowledge the likelihood of a significant interaction based on clinical experience and recommend separation of phenytoin from feedings. Au Yeung SCS, Ensom MHH. Phenytoin and enteral feedings: does evidence support an interaction? Ann Pharmacother 2000;34:896-905.

The following actions were taken by the Pharmacy and Therapeutics Committee during their meeting on 8/25/00:

Alosetron (Lotronex®) was added to the Formulary for use in patients with irritable bowel syndrome whose predominant symptom is diarrhea. Its use is restricted to the Gastroenterology Division.
Several changes were made in the proton pump inhibitors carried on our Formulary. The oral form of pantoprazole (Protonix,) was added. Lansoprazole (Prevacid®) was removed from the Formulary and the request for addition of rabeprazole (Aciphex,) was rejected.
A request for levobupivacaine (Chirocaine®) was rejected. It was not determined to offer significant advantages over racemic bupivacaine.

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Alprostadil (PGE1) for Maintaining Ductal Patency

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