We're giving her what??

  1. So has anyone else had experience with treating PPHN with Viagra? I read an article awhile back about it, but it seemed like it was still in the experimental phase. We have a baby now on it, and I don't know much about it or her case, other than the hype about the fact that we are using Viagra. I guess being in the big teaching hospital and all the new docs we recently got, there are going to be alot of interesting changes going on...

    This baby was born at 26 weeks, back in the summer, and it seems like this is the last-ditch effort to get her off INO. I have never taken care of her, so like I said, I don't know all that much about her case.
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  2. 17 Comments

  3. by   TexasPediRN
    Ive taken care of many kids with PPHN on Viagra. However, we go generic and call it Sildenifil (sounds better then saying 'hey, my kids on Viagra!)

    It seems to work pretty well - I dont understand the concept of how it works, just wanted to throw in my 2 cents that yes, I have seen it used before
  4. by   prmenrs
    I've heard of it, too. I'm not in a setting that would need it, but if it's "evident-based", why not? I'd agree w/using the generic name in front of parents and visitors!

    http://www.arainbowofhope.com/What_is_PPHN.html

    http://pediatrics.aappublications.or...ull/117/4/1077

    http://allnurses.com/forums/f33/viagra-nicu-16641.html

    http://allnurses.com/forums/f33/has-...hn-159441.html
    Last edit by prmenrs on Nov 22, '07
  5. by   Nightcrawler
    I am not sure about how long its been used in infants and kids, but it has been used in the adult population with PPH for quite some time. Medicare was having a fit about paying for it, and there were some issues with some of the Medicaid programs in various states because it was classed as an ED drug, is expensive, and adults on the med take it up to 6 times a day.
  6. by   rph3664
    Quote from Nightcrawler
    I am not sure about how long its been used in infants and kids, but it has been used in the adult population with PPH for quite some time. Medicare was having a fit about paying for it, and there were some issues with some of the Medicaid programs in various states because it was classed as an ED drug, is expensive, and adults on the med take it up to 6 times a day.
    Sildenafil is marketed for ED in 25, 50, and 100mg strengths. Since it's being used so much for PPH, Pfizer decided to market Revatio, which is a 20mg tablet and is approved for this purpose and is less of a hassle to get your insurance to pay for it.

    I understand that NICU sildenafil is in an IV preparation. My hospital doesn't have a Level III NICU so I have no personal experience with it.

    I have also seen Cialis used for this purpose. Did you know that the launch of Cialis was delayed for about a year because some people with the surname Cialis sued the drug company to have the name changed?
  7. by   preemieRNkate
    Quote from MeghanRN
    Ive taken care of many kids with PPHN on Viagra. However, we go generic and call it Sildenifil (sounds better then saying 'hey, my kids on Viagra!)
    Oh, I agree with you there, but who doesn't get a kick out of saying "Ok, time for your Viagra!" to a baby?? Actually, when they explained it to mom, they did tell her that basically, it's the PO form of INO (I believe they are giving it to her PO anyway).

    Interesting. Thanks everyone for your input!
  8. by   elkpark
    I don't have a source (too lazy to look one up), but I remember reading when Viagra first came on the market that it was originally developed/researched as a hypertension drug -- but so many of the male subjects in the clinical trials kept commenting on how much their sex lives had improved that Pfizer figured, well hey, there are tons of HTN drugs out there, but no one else has a drug that fixes your, umm, "sex life," so it would probably be much more profitable for them if they marketed it for that instead (and the rest is history... )

    So it does make sense.
  9. by   dawngloves
    A looooong time ago we did . Now we use nitric. Not sure why we stopped.
  10. by   rph3664
    Quote from elkpark
    I don't have a source (too lazy to look one up), but I remember reading when Viagra first came on the market that it was originally developed/researched as a hypertension drug -- but so many of the male subjects in the clinical trials kept commenting on how much their sex lives had improved that Pfizer figured, well hey, there are tons of HTN drugs out there, but no one else has a drug that fixes your, umm, "sex life," so it would probably be much more profitable for them if they marketed it for that instead (and the rest is history... )

    So it does make sense.
    You're on the right track.

    Pfizer was experimenting with drugs that would promote blood flow to the heart, and at first they wondered if the mens' increased sexual function was due to improved overall circulation. This turned out not to be the case, and it really didn't work that well for the heart circulation.

    I have filled more than one prescription for women who experienced sexual dysfunction after menopause or hysterectomy. When they call in their refills, they always preface it with, "You'll probably laugh at me, but....." No, I won't.

    As for Viagra's discoverers getting a Nobel Prize, it wasn't because of the sex thing but because it led to additional discoveries regarding the nitric oxide cycle, which is believed to play a role in things like Alzheimer's, cancer, strokes, and the overall aging process.
  11. by   Sweeper933
    Every once and a while we use Viagra on the chronic PPHN kids when nothing else seems to be working. We do get some funny looks from the parents at first, but it doesn't last. When I first saw a baby on our unit on Viagra it was kinda shocking... but then when I thought about how it does dilate blood vessels... it made a lot more sense!
  12. by   elizabells
    We use it on all our PPHN kids, and we actually DON'T have it IV. It's always PO. IIRC, as was posted upthread, it was originally created for HTN, and had a very profitable side effect.

    And yes, it has that same side effect on babies, too. Freaked the heck out of me the first time I encountered that... :uhoh21:
  13. by   preemieRNkate
    Quote from elizabells
    And yes, it has that same side effect on babies, too. Freaked the heck out of me the first time I encountered that... :uhoh21:
    Haha, I was wondering but I didn't want to ask anyone and seem like a pervert.
  14. by   NeuroNP
    Quote from elizabells
    We use it on all our PPHN kids, and we actually DON'T have it IV. It's always PO. IIRC, as was posted upthread, it was originally created for HTN, and had a very profitable side effect.

    And yes, it has that same side effect on babies, too. Freaked the heck out of me the first time I encountered that... :uhoh21:
    Several years ago I shadowed in the PICU and we had a kid who was getting it for PPHN. The kid was a boy about 6 (who was thankfully sedated and didn't realize it) and he did get the ...umm...side effect. His dad thought it was funny, his mom turned red when she came in the room (he was covered with a blanket, but...). It was funny for a while. Then it went on long enough that there started to be long-term damage risk. Urology actually said that he might suffer testicular damage and be unable to father children. But, taking him off the Viagra sent his PPHN through the roof. So, badness either way. What a horrible choice...I left that rotation before they figured out what to do, but I heard that Urology did some kind of procedure that was a temporary fix.

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