Alprostadil

Maintain Patency of Ductus Arteriosus, Erectile dysfunction

Intracavernosal Erectile dysfunction Adult: Initially, 2.5 mcg, followed by 5 mcg if there is partial response or 7.5 mcg if there is no response. Subsequent increments of 5-10 mcg are given until suitable dose is reached. Usual dose range: 5-20 mcg. Max: 60 mcg. For neurogenic origin (e.g. spinal cord injury): Initially, 1.25 mcg, followed by 2.5 mcg then 5 mcg, and subsequent increments of 5 mcg until suitable dose at intervals of at least 1 day for responders; for non-responders, a higher dose may be given w/in 1 hr. Max frequency: once daily; 3 times wkly. Diagnosis of erectile dysfunction Adult: 5-20 mcg as a single dose. Urethral Erectile dysfunction Adult: Initially, 250 mcg, may be increased in stepwise manner to 1,000 mcg; or reduced to 125 mcg according to response. Max frequency: twice daily; 7 doses wkly. Diagnosis of erectile dysfunction Adult: 500 mcg as a single dose. Topical/Cutaneous Erectile dysfunction Adult: As cream: Initially, 300 mcg is applied to the tip of the penis, may be reduced to 200 mcg if patient cannot tolerate AR. Max frequency: once daily; 2-3 times wkly.

Intravenous Maintenance of patency of ductus arteriosus in neonates with congenital heart disease Child: Initially, 0.05-0.1 mcg/kg/min via continuous infusion, reduced to the lowest possible dosage that maintains the response. If response is inadequate, may be increased up to 0.4 mcg/kg/min.

IV Preparation IV infusion: Dilute 1 mL (ie, 500 mcg) with sodium chloride for injection or dextrose Undiluted alprostadil solution may interact with plastic in volumetric infusion chambers resulting in a hazy solution (replace solution and volumetric infusion chamber if this occurs) Place appropriate amount of intravenous infusion solution (ie, sodium chloride, dextrose) in chamber first, then add undiluted alprostadil solution (avoid direct contact with walls of volumetric infusion chamber) Dilute to volumes appropriate for the pump delivery system available Prepare fresh infusion solutions q24hr; discard any solution >24 hr old IV Administration Administer via large vein or through umbilical catheter Administer IV injection via volumetric infusion pump

History of recurrent priapism, sickle cell anaemia or trait, multiple myeloma, leukaemia, thrombocythaemia, polycythaemia, predisposition to venous thrombosis, anatomical penile deformation (e.g. angulation, cavernosal fibrosis, Peyronie's disease, stenosis of distal urethra, severe hypospadias and curvature, balanitis, acute/chronic urethritis), penile implants. Patient for whom sexual activity is inadvisable (e.g. unstable CV or cerebrovascular conditions). Concomitant use w/ other drugs for erectile dysfunction (e.g. phosphodiesterase type 5 (PDE5) inhibitors, papaverine). Neonates w/ resp distress syndrome. Childn (intracavernosal).

Prolonged erection and priapism have occurred in patients receiving Alprostadil. To minimize the chances of this occurring, titrate Alprostadil slowly to the lowest effective dose. Advise patients to seek immediate medical assistance for an erection that persists longer than 4 hours. Penile fibrosis has occurred in patients receiving Alprostadil. Follow patients regularly to detect signs of penile fibrosis. Discontinue in patients who develop penile angulation or cavernosal fibrosis. Hypotension: Injections of Alprostadil can lead to increased peripheral blood levels of alprostadil, especially in patients with significant corpora cavernosa venous leakage. Avoid use in patients with known cavernosal venous leakage. Injection site bleeding may occur in patients taking anticoagulants, such as warfarin or heparin. Compress the site of injection with an alcohol swab or sterile gauze for 5 minutes. Cardiovascular risk related to underlying medical conditions: Underlying treatable medical causes of erectile dysfunction should be diagnosed and treated prior to initiation of therapy. Risks of use in combination with other vasoactive medications injected intracavernosally: Safety and efficacy of combinations of Alprostadil and other vasoactive agents have not been systematically studied. Use of such combinations is not recommended. Needle breakage: Alprostadil uses a superfine needle and cases of needle breakage have been reported. Careful instruction in proper patient handling and injection techniques may minimize this risk. Benzyl alcohol: Serious and fatal adverse reactions can occur in neonates and low birth weight infants treated with benzyl alcohol-preserved formulations in infusion solutions, including Alprostadil. Alprostadil is not indicated in neonates and infants. Counseling patients about sexually transmitted diseases: Counsel patients about the protective measures necessary to guard against sexually transmitted disease including the Human Immunodeficiency Virus (

Not Classi Pregnancy: Alprostadil not indicated for use in females Lactation: Alprostadil not indicated for use in females

Reduced effect w/ sympathomimetics, decongestants, and appetite suppressants. May enhance the effects of antihypertensives, vasoactive drugs, anticoagulants and platelet aggregation inhibitors. Potentially Fatal: Enhanced AR, including prolonged erections, w/ PDE5 inhibitors (e.g. sildenafil, tadalafil, vardenafil) and other drugs that induce erection (e.g. papaverine).

>10% Fever (14%) Apnea (12%) Flushing (>10%) 1-10% Bradycardia (7%) Hypotension (4%) Seizures (4%) Tachycardia (3%) Diarrhea (2%) Sepsis (2%) Cardiac arrest (1%) Edema (1%) Intravascular coagulation (1%) Hypokalemia (1%) <1% Cerebral bleeding Hyperextension of the neck Hyperirritability Hypothermia Jitteriness Lethargy Stiffness Congestive heart failure Hyperemia Second degree heart block Shock Spasm of the right ventricle infundibulum Supraventricular tachycardia Ventricular fibrillation Bradypnea Bronchial wheezing Hypercapnia Respiratory depression Respiratory distress Tachypnea Gastric regurgitation Hyperbilirubinemia Anemia Bleeding Thrombocytopenia Peritonitis Hypoglycemia Hyperkalemia

Alprostadil, a naturally occurring prostaglandin E1, is a vasodilating agent and a platelet aggregation inhibitor. It induces erection by relaxation of the trabecular smooth muscles and dilation of cavernosal arteries, allowing blood flow to the lacunar spaces of the penis. It also relaxes the smooth muscles of the ductus arteriosus.