alprostadil (Muse, Caverject, Edex, Prostin VR pediatric, Topiglan, Befar)

Introduction

Tradenames: Muse, Caverject, Edex, Prostin VR pediatric. Prostaglandin E1.

Indications

• impotence
• congenital heart defect
  • temporary maintenance of patent ductus arteriosus in neonates with ductal-dependent congenital heart disease until surgery can be performed
  • coarctation of the aorta
• pulmonary hypertension
  • pulmonary artery stenosis
• peripheral vascular disease, peripheral arterial disease

Contraindications

• intracavernous injection
  • sickle cell disease
  • unstable cardiac disease
  • anticoagulant therapy

pregnancy category = x

Dosage

• impotence
  • 1 intraurethral pellet (Muse)
  • intracavernosal injection (Caverject, Edex)
  • use lowest dose necessary to produce erection
• congenital heart disease
  • 0.05-0.1 ug/kg/min through an umbilical catheter with tip at the ductal opening
  • adjust dose to lowest effective dose for therapeutic response

Muse: 125, 250, 500, 1000 ug.

Caverject: 6.15, 11.9, 23.3 ug

Edex: 5, 10, 20, 40 ug

Adverse effects

• common (> 10%)
  • flushing
  • fever
  • penile pain
  • apnea 2)less common (1-10%)
    • bradycardia, hypotension, hypertension, tachycardia, cardiac arrest, edema, seizures, headache, dizziness, hypokalemia, diarrhea, prolonged erection, penile fibrosis, penile edema, disseminated intravascular coagulation, injection site hematoma or ecchymosis, back pain, upper respiratory tract infection, flu-like syndrome, sinusitis, nasal congestion, cough, sepsis, localized pain at sites other than the injection site
• uncommon (< 1%)
  • cerebral bleeding, congestive heart failure, 2nd degree heart block, shock, supraventricular tachycardia, ventricular fibrillation, hyperemia, hyperirritability, hypothermia, jitteriness, lethargy, hypoglycemia, hyperkalemia, gastric regurgitation, anuria, balanitis, urethral bleeding, penile numbness, yeast infection, penile pruritus & erythema, abnormal ejaculation, anemia, bleeding, thrombocytopenia, hyperbilirubinemia, hyperextension of the neck, hematuria, bradypnea, wheezing, peritonitis

More general terms

• prostaglandin E1
• miscellaneous pharmacologic agent

Additional terms

• misoprostol (Cytotec)

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5280723
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=12943
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=214