Obliterating diseases of the arteries (III and IV stages according to Fontaine's classification, accompanied by pain at rest or trophic changes); obliterating endarteritis with severe intermittent claudication in the presence of contraindications to revascularization surgery.Improves the quality of life and increases the physical capabilities of patients with obliterating diseases of the arteries: 60 μg intravenously drip for 2 hours. Inferior to the effectiveness of iloprost. Intermittent claudication: according to RCT, prostaglandin E1 in comparison with pentoxifylline (PGE1 - 40 μg in 250 ml of 0.9% sodium chloride solution intravenously drip for 2 hours 2 times a day, pentoxifylline - in 250 ml of 0.9% solution of sodium chloride intravenously drip for 2 hours 2 times a day) significantly increased the painless walking distance (average distance 416 m, 95% CI 28-804), but did not affect the maximum walking distance (1 RCT, 29 participants). In other studies, there is no standard deviation, so it is not possible to analyze the effect of drugs on the walking distance. According to these studies (2 RCTs, 240 participants), there was no difference in the ankle-brachial pressure index between the groups. PGE1 increased the average painless walking distance from 83 to 264 m in one study and from 89 to 195 m in the other, pentoxifylline - from 84 to 188 m and from 78 to 149 m, respectively.
Atherosclerosis. 120 mcg / day intravenously. Diabetic angiopathy: ineffective. Berger's disease.Reynaud's syndrome with trophic disorders. 60 μg intravenously drip for 3 hours daily. Vasculitis. Systemic scleroderma. 60 mcg iv in for 3 h daily. Sucks in gastrocnemius muscles.
Damage by physical factors, especially extreme vibration. Intraarterially (with the help of an infusion pump) 10-20 mcg for 1-2 hours once a day or 0.1-0.6 ng / kg × min (5-10 mcg) through the established catheter for 12 hours. Intravenous by 40 μg 2 times a day (after preliminary dissolving the contents of the ampoule in 50 ml of 0.9% sodium chloride solution) or 50-200 μg once a day (in more severe conditions, 50-100 μg twice a day); duration of infusion - at least 2 hours. In the absence of a positive effect within 2 weeks after the start of treatment, further use is stopped.
If renal function is impaired (creatinine concentration in the blood serum> 1.5 mg / l), intravenous administration starts with a dose of 20 μg. If necessary, after 2-3 days, the single dose is increased to 40-60 μg. For patients with renal and heart failure, the maximum volume of injected fluid is 50-100 ml / day. The course of treatment - 4 weeks. The clinical effect is long-term and may occur with some delay after the end of the course of treatment.
Violations of the erection of neurogenic, vascular, psychogenic or mixed etiology.
Intracavernous 5-10 mcg once a week, 125-1000 mcg transurethral in 4 doses for a 2-4-week period. Treatment with self-injections at home should start with a dose set in the doctor's office, no more than 1 time per day and 3 times a week. The onset of action is 5-10 minutes, duration 1-3 hours.
The dose is selected individually before the minimum effective dose (the appearance of an erection sufficient for sexual intercourse, but no more than 1 hour), under the supervision of a doctor until the erection disappears. If the first dose is ineffective, the second, higher, is administered after 1 hour. If the second dose is ineffective, the third, even higher, is administered no earlier than 1 day later. In cases of erectile dysfunction of a neurogenic genesis (for example, with damage to the spinal cord), the initial dose is 1.25 μg. With each subsequent administration, the dose is doubled, but not more than 5 μg, until the minimum effective dose is reached. In cases of erectile dysfunction of vascular, psychogenic or mixed etiology, the initial dose is 2.5 μg. For each subsequent administration, the dose should be doubled, but not more than 5-10 μg, until the minimum effective dose is reached.Intraurethral in the form of suppositories, the initial dose of 125-250 mcg; if necessary, the dose is gradually raised or lowered until an erection sufficient for a sexual intercourse arises. The maximum frequency of application is 2 times a day. Effective for erectile dysfunction of various etiologies. Intracavernous administration at a dose of 40-1000 μg is superior in effectiveness to intraurethral injection, but more difficult to apply. It surpasses the efficiency of moxizilite chlor-hydrate; comparable to a vacuum device. Inferior to sodium nitroprusside in a dose of 300-400 micrograms intracavernous. Intraurethral, in the form of applications is ineffective; possible use in combination with phentolamine intracavernous.
Psychogenic erectile dysfunction: intracavernous 2.5-5.0 mcg is more economical than psychotherapy.
Erectile dysfunction after treatment of prostate cancer - the most convincing evidence is obtained for oral PDE-5 inoculants after radiotherapy for prostate cancer and radical prostatectomy. In the transurethral administration of alprostadil, 270 participants from 384 reported an acceptable improvement in erection, 35% had an effective dose of 1000 μg, 31% had 500 μg, 17% had 250 μg and 17% had 125 μg.270 men were divided into two groups - alprostadil treatment group and placebo group. The OR of successful coitus was at least 1 time for 3 months and was significant in favor of treatment - 18.96 (95% CI 8.85-40.65), a wide confidence interval indicates insufficient research opportunities and the need to interpret its results carefully. Significantly more often in the treatment group alprostadil there was pain in the penis (OR - 75.73, 95% CI 10.27-558.4), pain and burning in the urethra (OR 4.66, 95% CI 1.91-12, 42). In the active group, 2% experienced dizziness. According to the authors' conclusions, PDE-5 inhibitors are effective in the treatment of secondary erectile dysfunction after treatment of prostate cancer. Other methods need further investigation.
Carrying out a pharmacological test in a complex of diagnostic tests for erectile dysfunction: once in a dose that causes an erection.
Use in children
The need to temporarily maintain the functioning of the arterial duct before the corrective operation for congenital heart defects in newborns (including mitral atresia, pulmonary atresia, tricuspid valve, tetralogy of Fallot).Intravenous drip: for newborns the initial dose is 50-100 ng / kg × min, then it is reduced to the minimum effective. Lower doses (10 ng / kg × min) may be more effective and safer. Continuously through the umbilical arterial catheter (brought directly to the mouth of the arterial duct) or one of the large veins with an initial rate of 0.05-0.1 (up to 0.4) μg / kg × min. After reaching the therapeutic effect, 0.01-0.02 μg / kg × min (0.005-0.01 C21). When there are significant side effects, the dose should be reduced.