Intravenous Pulmonary Vasodilators Physicochemical and Pharmacokinetic Characteristics
Drug Log P Protein Binding (%) Metabolism / Elimination Dose Adjustment on ECMO Dose Range
           
Alprostadil 3.2 81 ~70% to 80% by oxidation during a single pass through the lungs -
Adult: 5–100 ng/kg/min
Pediatric: 5–100 ng/kg/min
Neonate: 10–200 ng/kg/min
Epoprostenol 2.4 90 Hydrolyzed in blood and enzymatic degradation -
Adult: 2–80 ng/kg/min
Pediatric: 2–80 ng/kg/min
Neonate: 2–80 ng/kg/min
Sildenafil 2.7 96 Hepatic -
Adult: 10 mg IV every 8 hrs
Pediatric: 0.125–0.25 mg/kg/dose IV every 8 hrs; Max Dose: 10 mg IV every 8 hrs
Neonate: 0.25–0.5 mg/kg IV every 6–8 hrs

Neonatal Infusion for Congenital Diaphragmatic Hernia: Loading Dose: 0.4 mg/kg administered over 3 hours followed by continuous IV infusion of 1.6 mg/kg/day

Treprostinil 1.4 91 Hepatic -
Adult: 1.25–80 ng/kg/min
Pediatric: 1.25–80 ng/kg/min
Neonatal: 2–60 ng/kg/min
- Minimal sequestration; no need for dose adjustment
++ Moderate sequestration; may require dose adjustment
+++ Significant sequestration; need for dose adjustment