VAP (Concentrate) Instructions for Use

ATC Code

C01EA01 (Alprostadil)

Active Substance

Alprostadil (Rec.INN registered by WHO)

Clinical-Pharmacological Group

Vasodilator drug – synthetic prostaglandin E₁ analogue

Pharmacotherapeutic Group

Vasodilating agent – synthetic prostaglandin E₁ analogue

Pharmacological Action

A prostaglandin E₁ drug. It improves microcirculation and peripheral circulation and has an angioprotective effect.

During systemic administration, it causes relaxation of smooth muscle fibers, has a vasodilating effect, reduces total peripheral vascular resistance, and lowers blood pressure. A reflex increase in cardiac output and heart rate is noted. It improves the rheological properties of blood by increasing the elasticity of erythrocytes and reducing platelet aggregation and neutrophil activity, and increases the fibrinolytic activity of blood.

It has a stimulating effect on the smooth muscles of the intestine, bladder, and uterus; it suppresses the secretion of gastric juice.

During intracavernous administration, it blocks α₁-adrenergic receptors in the tissues of the penis, has a relaxing effect on the smooth muscles of the cavernous bodies, and promotes increased blood flow and improved microcirculation.

Dilation of the cavernous arteries and vessels of the trabecular smooth muscles of the cavernous bodies leads to a rapid increase in blood inflow and dilation of the lacunar spaces in the cavernous bodies. Venous outflow through the vessels located under the tunica albuginea is limited, which stimulates the development of an erection (the “corporal veno-occlusive mechanism”). Onset of action is 5-10 minutes, duration is 1-3 hours.

Pharmacokinetics

When administered intravenously, Alprostadil is rapidly metabolized. During a single pass through the lungs, 60-90% is metabolized.

Enzymatic oxidation produces 3 biologically active metabolites: 15-keto-PGE₁, 15-keto-13,14-dihydro-PGE₁, and 13,14-dihydro-PGE₁. The keto-metabolites have a lower biological effect compared to alprostadil; the metabolite 13,14-dihydro-PGE₁ has an effect comparable to PGE₁. The pharmacodynamic effect is mainly due to this biologically active metabolite. The T_1/2 of 13,14-dihydro-PGE₁ is about 1 minute. The main metabolites are excreted primarily in the urine and to a lesser extent in the feces.

During intracavernous administration, the concentration of alprostadil and its main metabolite – 15-oxo-13,14-dihydro-PgE₁ – is determined only in the cavernous bodies. After intracavernous administration of 20 mcg of alprostadil, the content of the main metabolite in the peripheral bloodstream increased and reached a maximum 30 minutes after the injection, then returned to the initial level 60 minutes after the injection, while the levels of alprostadil in the peripheral bloodstream were slightly higher than the initial levels.

Alprostadil, upon entering the systemic circulation during intracavernous administration, is very rapidly metabolized. It is excreted in the form of metabolites.

Indications

The need for temporary maintenance of the function of the arterial duct until corrective surgery is performed for congenital ductus-dependent heart defects in newborns (including mitral atresia, pulmonary artery atresia, tricuspid valve atresia, tetralogy of Fallot).

Chronic obliterating arterial diseases of stages III-IV (according to the Fontaine classification). Obliterating endarteritis with severe intermittent claudication (when surgical revascularization of the lower limb is impossible), obliterating atherosclerosis, diabetic angiopathy, obliterating thromboangiitis (Buerger’s disease), Raynaud’s syndrome with trophic disorders, vasculitis, scleroderma, calf muscle cramps, damaging effects of physical factors, especially excessive vibration.

Treatment of erectile dysfunction of neurogenic, vascular, psychogenic, or mixed etiology; performing a pharmacological test as part of diagnostic tests for erectile dysfunction.

ICD codes

Dosage Regimen

Determine the dosage individually based on the indication, clinical condition, and patient response.

For neonatal ductus arteriosus maintenance, administer a continuous intravenous infusion. Initiate at 0.05-0.1 mcg/kg/minute. Titrate to the lowest effective dose, not exceeding 0.4 mcg/kg/minute. Monitor arterial pressure and respiratory status continuously.

For chronic critical limb ischemia (Fontaine stages III-IV), administer via intra-arterial infusion. The initial dose is 0.05-0.1 mcg/kg/minute for several hours daily. The infusion duration and course length depend on the clinical response. Alternatively, use a prolonged intravenous infusion at 0.05-0.2 mcg/kg/minute for several hours daily over a period of 2-4 weeks.

For erectile dysfunction, use the appropriate formulation for intracavernous injection only. The initial dose is 2.5 mcg. If the response is inadequate, increase the dose in 2.5-5.0 mcg increments to a maximum of 60 mcg per injection. Determine the final dose providing an erection not exceeding one hour. The maximum frequency of administration is once daily and three times per week. Administer the injection into the lateral aspect of the penis, alternating sides.

For all routes, strictly adhere to the specific formulation’s approved indications and administration guidelines. Do not interchange formulations.

Adverse Reactions

From the digestive system: diarrhea, nausea, vomiting, increased transaminase activity; rarely – hyperbilirubinemia, peritoneal symptoms.

From the cardiovascular system: arterial hypotension, tachycardia, pain in the heart area; rarely – heart failure, cardiac arrhythmias, AV block, acute pulmonary edema.

From the central and peripheral nervous system: headache, psychoses, seizures of central origin, paresthesia; rarely – lethargy.

From the respiratory system: rarely – tachypnea, respiratory distress syndrome.

From the hematopoietic system and blood coagulation system: leukocytosis, leukopenia; rarely – bleeding, hypochromic anemia, thrombocytopenia.

From the urinary system: rarely – anuria, renal failure, hematuria.

From metabolism: rarely – hypoglycemia, hypercapnia.

From the musculoskeletal system: joint pain, neck muscle tension, reversible hyperostosis of tubular bones.

Allergic reactions: skin rash, itching.

Other: hyperthermia, skin redness, increased sweating, swelling of the limb into which the infusion is performed are possible.

During intracavernous administration: pain in the penis, prolonged erection and priapism are possible; rarely – fibrosis, edema, feeling of heat, numbness, rashes on the penis, balanitis, hemorrhages, itching and swelling at the injection site, bleeding from the urethra, fungal infection, phimosis, painful erection and impaired ejaculation, pain in the testicles, testicular swelling, pain and tension in the scrotum, frequent urination, urinary incontinence, pain in the buttocks, legs, abdomen, pain in the pelvic area, lower back, flu-like syndrome, hypesthesia, myasthenia.

Contraindications

Chronic heart failure, pulmonary edema, cardiac arrhythmias, myocardial infarction within the last 6 months; infiltrative changes in the lungs, bronchial asthma; impaired liver function, liver diseases (including in the anamnesis); history of ulcerative lesions of the gastrointestinal tract; hypersensitivity to alprostadil; pregnancy, lactation.

For intracavernous administration: diseases predisposing to the occurrence of priapism (sickle cell anemia, multiple myeloma, leukemia); anatomical deformities of the penis (angulation, cavernous fibrosis, Peyronie’s disease). Not used in patients with a penile implant, as well as when sexual intercourse is contraindicated.

Use in Pregnancy and Lactation

Alprostadil is contraindicated during pregnancy and during the period of lactation (breastfeeding).

Use in Hepatic Impairment

Contraindication: impaired liver function, liver diseases (including in the anamnesis).

Pediatric Use

In newborns, it should be used under constant blood pressure monitoring, with mandatory availability of conditions for artificial lung ventilation.

There is currently no experience with intracavernous administration in patients under 18 years of age.

Geriatric Use

There is currently no experience with intracavernous administration in patients over 75 years of age.

Use intra-arterially and intravenously with caution in cases of extensive vascular lesions in diabetes mellitus (in elderly patients).

Special Precautions

Use intra-arterially and intravenously with caution in acute and subacute myocardial infarction, in myocardial infarction within the last 6 months, in severe or unstable angina, decompensated chronic heart failure, in arterial hypotension, cardiovascular failure, in pulmonary edema, severe arrhythmias, bronchial obstruction syndrome (severe degree with signs of respiratory failure), in infiltrative changes in the lungs, liver failure (including in the anamnesis), with an increased risk of bleeding (including with gastric or duodenal ulcer, severe cerebrovascular disease, proliferative retinopathy with a tendency to bleeding, extensive trauma), hemodialysis, type 1 diabetes mellitus, especially with extensive vascular lesions (in elderly patients); while using vasodilators or anticoagulants; in newborns (risk of bradypnea, arterial hypotension, tachycardia or hyperthermia).

Administer intracavernously with caution in thrombocytopenia, polycythemia, thrombophlebitis, venous thrombosis (including in case of predisposition), increased blood viscosity, balanitis, urethritis.

Should not be used in patients with a tendency to drug addiction and/or mental or intellectual disorders.

In case of blood coagulation disorders or during simultaneous therapy with drugs that affect the coagulation system, blood coagulation parameters should be regularly monitored during treatment with alprostadil. During systemic administration, monitoring of central hemodynamic parameters and blood biochemical parameters is necessary.

During long-term continuous administration, the development of apnea, a negative effect on the structure of the arterial duct wall with an increased risk of its rupture, and thinning of the muscular layer of the pulmonary artery are possible. With treatment duration of more than 4 weeks, reversible cortical proliferation of tubular bones is possible.

In newborns, it should be used under constant blood pressure monitoring, with mandatory availability of conditions for artificial lung ventilation.

There is currently no experience with intracavernous administration in patients under 18 years of age and over 75 years of age.

Alprostadil is not intended for simultaneous use with other drugs for the treatment of erectile dysfunction.

The correspondence of the used dosage form of alprostadil to the specific indications for its use must be strictly observed.

Drug Interactions

With simultaneous use, Alprostadil enhances the effect of antihypertensive agents and vasodilators, anticoagulants, and antiplatelet agents.

Storage Conditions

Store at 2°C (36°F) to 8°C (46°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Rx Only

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.