AHFS Class:

24:08.16 Direct Vasodilators

Alprostadil for intravenous use is available as a 500-mcg/mL concentrate for injection in dehydrated alcohol packaged in ampuls and vials.³⁶³⁷; ³⁶³⁸ The concentrate for injection must be diluted in a compatible infusion solution prior to administration.³⁶³⁷; ³⁶³⁸

Trade Name(s)

Prostin VR Pediatric

Alprostadil concentrate for injection must be diluted in a compatible infusion solution prior to administration.³⁶³⁷; ³⁶³⁸ The diluted solution for infusion must be infused continuously.³⁶³⁷; ³⁶³⁸ The preferred route of administration for alprostadil is continuous infusion into a large vein.³⁶³⁷; ³⁶³⁸ Alternatively, alprostadil may be administered through an umbilical artery catheter placed at the ductal opening.³⁶³⁷; ³⁶³⁸

For continuous intravenous or intra-arterial infusion in neonates, 500 mcg (1 mL) of alprostadil concentrate for injection is added to 25, 50, 100, or 250 mL of a compatible infusion solution to yield solutions with alprostadil concentrations of 20, 10, 5, or 2 mcg/mL, respectively.³⁶³⁷; ³⁶³⁸

Intact containers of alprostadil concentrate for injection should be stored under refrigeration at 2 to 8°C.³⁶³⁷; ³⁶³⁸ The manufacturer states that diluted solutions of alprostadil concentrate for injection should be prepared every 24 hours; any diluted solution prepared more than 24 hours prior should be discarded.³⁶³⁷; ³⁶³⁸

Undiluted alprostadil concentrate for injection may interact with plastic walls of volumetric infusion chambers, changing their appearance and resulting in a hazy solution; in such cases, the solution and volumetric infusion chamber should be replaced.³⁶³⁷; ³⁶³⁸ Consequently, the infusion solution should be added to the volumetric infusion chamber first with the alprostadil concentrate for injection added into the solution, avoiding direct contact of the undiluted concentrate for injection with the chamber walls.³⁶³⁷; ³⁶³⁸

pH Effects

Alprostadil is more stable at acidic pH values compared with neutral and especially alkaline pH values. The pH of maximum stability has been reported to be pH 3.²⁶³⁹

Light Effects

Alprostadil is reported not to be subjected to increased degradation due to ambient light exposure.²⁶³⁹

Syringes

Alprostadil undiluted at a concentration of 500 mcg/mL and also prepared diluted with sodium chloride 0.9% at concentrations near 250 and 125 mcg/mL was packaged in 1-mL polypropylene syringes (Becton Dickinson). After 30 days stored at 4°C, 5% or less alprostadil loss occurred.²⁶⁰²

Standardize 4 Safety

One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.

Table 1. Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Alprostadil³⁶³⁵

Solution Compatibility

Drugs in Syringe Compatibility

Y-Site Injection Compatibility (1:1 Mixture)

Additional Compatibility Information

Epinephrine Bitartrate

Epinephrine bitartrate (Braun) 0.2 mg/mL in dextrose 5% protected from light with alprostadil (Pfizer) 20 mcg/mL in dextrose 5% was physically compatible for up to 4 hours at 22 to 25°C during a simulated Y-site administration study.³⁶⁶⁴; ³⁶⁸⁰

Morphine Hydrochloride

Morphine hydrochloride (Braun) 2 mg/mL in sodium chloride 0.9% protected from light with alprostadil (Pfizer) 20 mcg/mL in dextrose 5% was physically compatible for up to 4 hours at 22 to 25°C during a simulated Y-site administration study.³⁶⁶⁴; ³⁶⁸⁰

For a list of references cited in the text of this monograph, search the monograph titled References.

ASHP^® Injectable Drug Information^TM. Selected Revisions December 5, 2024. © Copyright, 2024. American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.