Prostin VR Pediatric, Caverject, Muse, Edex
Classifications: prostaglandin; Therapeutic: prostaglandin
Pregnancy Category: C
500 mcg/mL injection; 5 mcg/mL, 10 mcg/mL, 20 mcg/mL, 40 mcg/mL powder for injection; 125 mcg, 250 mcg, 500 mcg, 1000 mcg pellets
Preserves ductal patency by relaxing smooth muscle of ductus arteriosus. Alprostadil induces penile erection by relaxing
the smooth muscles of the corpus cavernosum and dilating the cavernosal arteries and their penile arterioles. Sufficient
rigidity of the penis also requires increased venous outflow resistance.
Preserves ductal patency by relaxing smooth muscle of ductus arteriosus. It induces penile rigidity and erection by penile
Temporary measure to maintain patency of ductus arteriosus in infants with ductal-dependent congenital heart defects until
corrective surgery can be performed. Also used in erectile dysfunction.
Ductus arteriosus respiratory distress syndrome (hyaline membrane disease); neonates with respiratory distress syndrome;
hypersensitivity to alprostadil; patients with penile implants. Muse, Edex: Women, children, and newborns; lactation. Muse: Patients with urethral stricture, inflammation/infection of glans of penis, severe hypospadias, acute or chronic urethritis;
sickle cell anemia or trait, thrombocytopenia, thrombocytosis; polycythemia, multiple myeloma.
Ductus arteriosus; bleeding tendencies; cardiovascular disease; erectile dysfunction; hypersensitivity to alprostadil; leukemia;
penile anatomic deformations; patients on anticoagulants, vasoactive or antihypertensive drugs.
Route & Dosage
|To Maintain Patency of Ductus Arteriosus
Neonate: IV/Intraarterial/Intraaortic 0.050.1 mcg/kg/min, may increase gradually (max: 0.4 mcg/kg/min if necessary)
Erectile Dysfunction of Vasculogenic, Psychogenic, or Mixed Etiology
Adult: Intracavernosal Initiate with 2.5 mcg; if inadequate response, increase dose by 2.5 mcg. May then increase dose in 5- to 10-mcg increments
until a suitable erection occurs, not exceeding 1 h in duration. Doses >60 mcg not recommended
Erectile Dysfunction of Pure Neurogenic Etiology
Adult: Intracavernosal Initiate with 1.25 mcg; if inadequate response, increase dose by 1.25 mcg, then increase by 2.5 mcg, may then increase dose
in 5 mcg increments until a suitable erection occurs, not exceeding 1 h in duration. Doses >60 mcg not recommended
- Administer only after proper training in the penile injection technique. Refer to information on administration provided
to the patient by the manufacturer.
- Use reconstituted solutions immediately.
- Store dry powder at or below 25° C (77° F) for up to 3 mo. Do not freeze.
- Refer to information on insertion into the urethra provided to the patient by the manufacturer.
PREPARE: Continuous: ??Dilute 500 mcg alprostadil with NS or D5W to volume appropriate for pump delivery system.??Prepare fresh solution q24h. Discard unused portions.??A 500 mcg ampule diluted in 250 mL yields a concentration of 2 mcg/mL.
ADMINISTER: Continuous: Infuse at rate of 0.050.1 mcg/kg/min up to a maximum of 0.4 mcg/kg/min. ??Reduce infusion rate immediately if arterial pressure drops significantly or if fever occurs.??Discontinue promptly, if apnea or bradycardia occurs.
- Store at 2°8° C (36°46° F) unless otherwise directed by manufacturer. Protect from freezing.
Adverse Effects (≥1%)CNS: Fever,
seizures, lethargy. CV: Flushing,
bradycardia, hypotension, syncope, tachycardia; CHF, ventricular fibrillation, shock. GI: Diarrhea
, gastric regurgitation. Hematologic: Disseminated intravascular coagulation
Oliguria, anuria. Penile pain,
prolonged erection, priapism, penile fibrosis, injection site hematoma/ecchymosis, penile rash and edema, prostatitis,
perineal pain. Skin:
Rash on face and arms, alopecia
May increase anticoagulant properties of warfarin; antihypertensive agents
increase risk of hypotension.
15 min to 3 h. Metabolism:
Rapidly in lungs. Elimination:
Through kidneys. Half-Life:
Assessment & Drug Effects
- Monitor therapeutic effectiveness which is indicated by increase in blood oxygenation (Po2), usually evident within 30 min, in infants with cyanotic heart disease (restricted pulmonary blood flow). Normal Po2 for neonates is 6070 mm Hg. Indicated by increased pH in those with acidosis, increased systemic BP and urinary output,
return of palpable pulses, and decreased ratio of pulmonary artery to aortic pressure in infants with restricted systemic
- Monitor for arterial pressure, ECG, heart rate, BP, respiratory rate, and rectal temperature, intermittently throughout the
- Lab tests: Monitor arterial blood gases and arterial blood pH intermittently throughout the infusion.
- Monitor: Systemic BP, pulmonary artery and descending aorta pressures, femoral pulse, and urinary output.
Patient & Family Education
- Follow carefully directions for penile injection provided by the manufacturer.
- Do not change dose without consulting the physician.
- Do not use intracavernosal injection more often than 3 times/wk; allow at least 24 h between uses.
- Do not use more than 2 urethral suppository systems in a 24 h period.
- Report nodules or hard tissue in penis; penile pain, redness, swelling, tenderness; or curvature of the erect penis to the
physician as soon as possible.
- Seek immediate medical attention if an erection persists longer than 6 h.