Colfosceril Palmitate

Usage

Colfosceril palmitate is prescribed for the prevention and treatment of Respiratory Distress Syndrome (RDS) (or Neonatal Respiratory Distress Syndrome) in premature newborns with a birth weight of 700 grams or greater, who are undergoing mechanical ventilation. It is a synthetic lung surfactant. Its pharmacological classification is pulmonary surfactant. It works by mimicking the actions of natural lung surfactant, reducing surface tension within the alveoli, and thus improving lung compliance and gas exchange.

Alternate Names

Synthetic surfactant; Dipalmitoylphosphatidylcholine (DPPC). A previous brand name was Exosurf Neonatal (discontinued).

How It Works

Pharmacodynamics: Colfosceril palmitate replaces deficient or ineffective endogenous lung surfactant, primarily dipalmitoylphosphatidylcholine (DPPC). By adsorbing to the air-liquid interface in the alveoli, it reduces surface tension, thereby preventing alveolar collapse during expiration and improving lung compliance. This, in turn, enhances gas exchange (oxygen uptake and carbon dioxide removal) and reduces the work of breathing.

Pharmacokinetics:

• Absorption: Administered directly into the lungs via the endotracheal tube, thus bypassing systemic absorption. Distribution is primarily within the lungs, although small amounts can enter the systemic circulation, especially in the presence of lung injury.
• Metabolism: Colfosceril palmitate is catabolized within the lung tissue and can be reutilized for further surfactant synthesis and secretion.
• Elimination: Primarily eliminated via exhalation. Minor pathways include renal and fecal excretion. Half-life reported in the range of 20-36 hours.

Mode of Action: Acts by directly reducing surface tension at the air-liquid interface in the alveoli.

Receptor binding, enzyme inhibition, or neurotransmitter modulation: No direct interaction with receptors, enzymes, or neurotransmitters.

Elimination pathways: Primarily exhaled air; minor renal and fecal excretion.

Dosage

Standard Dosage

Adults: Not applicable. Colfosceril palmitate is specifically indicated for neonatal use.

Children (Neonates):

• Standard Dose: 5.8 mL/kg birth weight (equivalent to approximately 100mg phospholipids/kg). The total dose is divided into four equal aliquots administered intratracheally. After each aliquot instillation, the infant is positioned differently (supine, prone, right lateral decubitus, and left lateral decubitus) to ensure even distribution of the surfactant throughout the lungs.
• Frequency: Repeat doses can be given every 6 hours, up to a maximum of four doses within the first 48 hours of life.
• Pediatric Safety Considerations: Requires close monitoring of heart rate, oxygen saturation, and arterial blood gases during and after administration due to the potential for rapid changes in oxygenation and lung compliance. Endotracheal tube reflux and blockage are possible complications, therefore suctioning before and as needed after administration is important.

Special Cases: Dosage adjustments in special populations have not been specifically studied.

Clinical Use Cases

• Intubation: Administered after intubation for the rescue treatment of RDS.
• Mechanical Ventilation: Used in conjunction with mechanical ventilation to support respiration in neonates with RDS.
• Intensive Care Unit (ICU) Use: Administered in the NICU setting for the management of RDS in premature infants.

Dosage Adjustments: Limited information available. Dose modifications are not routinely recommended based on renal or hepatic function due to the localized pulmonary administration and minimal systemic absorption.

Side Effects

Common Side Effects:

• Bradycardia
• Hypotension
• Oxygen desaturation (transient)
• Endotracheal tube reflux or obstruction

Rare but Serious Side Effects:

• Pulmonary hemorrhage
• Pneumothorax
• Pulmonary interstitial emphysema

Long-Term Effects: Not typically applicable due to the short-term use in the neonatal period.

Adverse Drug Reactions (ADR): Rapid deterioration in oxygenation or ventilation, requiring immediate intervention.

Contraindications

• Congenital abnormalities incompatible with life.
• Congenital diaphragmatic hernia.

Drug Interactions

No clinically significant drug interactions have been reported.

Pregnancy and Breastfeeding

Not applicable. Colfosceril palmitate is used in neonates after birth. Antenatal corticosteroids may be given to the mother to promote fetal lung maturation.

Drug Profile Summary

• Mechanism of Action: Replaces deficient surfactant, reduces alveolar surface tension, improves lung compliance, and enhances gas exchange.
• Side Effects: Bradycardia, hypotension, oxygen desaturation, endotracheal tube complications, pulmonary hemorrhage, pneumothorax.
• Contraindications: Life-incompatible congenital anomalies, congenital diaphragmatic hernia.
• Drug Interactions: None reported.
• Pregnancy & Breastfeeding: Not applicable (neonatal use).
• Dosage: 5.8 mL/kg birth weight, divided into four aliquots, administered intratracheally; repeat doses every 6 hours, up to four doses in 48 hours.
• Monitoring Parameters: Heart rate, oxygen saturation, arterial blood gases, endotracheal tube patency.

Popular Combinations

Frequently used with mechanical ventilation and oxygen therapy. No specific drug combinations are routinely recommended.

Precautions

• General Precautions: Administer only by trained personnel experienced in neonatal resuscitation and intubation. Ensure adequate ventilation and oxygenation monitoring.
• Specific Populations (Neonates): Close monitoring for changes in respiratory status and potential complications.
• Lifestyle Considerations: Not applicable.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Colfosceril Palmitate?

A: 5.8 mL/kg birth weight, divided into four equal aliquots, administered intratracheally. Repeat doses can be given every 6 hours as needed, up to a maximum of four doses in the first 48 hours of life.

Q2: How is Colfosceril Palmitate administered?

A: Intratracheally, via a 5-French end-hole catheter inserted into the endotracheal tube. The infant should be positioned differently for administration of each aliquot.

Q3: What are the common side effects of Colfosceril Palmitate?

A: Common side effects include bradycardia, hypotension, transient oxygen desaturation, and endotracheal tube reflux or obstruction.

Q4: What are the serious side effects of Colfosceril Palmitate?

A: Rare but serious side effects include pulmonary hemorrhage, pneumothorax, and pulmonary interstitial emphysema.

Q5: What are the contraindications for using Colfosceril Palmitate?

A: It is contraindicated in neonates with congenital abnormalities incompatible with life and congenital diaphragmatic hernia.

Q6: How often can Colfosceril Palmitate be administered?

A: Repeat doses can be given every 6 hours, up to a maximum of four doses in the first 48 hours of life.

Q7: Does Colfosceril Palmitate interact with any other medications?

A: No significant drug interactions have been reported.

Q8: What precautions should be taken when administering Colfosceril Palmitate?

A: It should be administered by trained personnel experienced in neonatal resuscitation and intubation. Close monitoring of respiratory status, heart rate, and oxygen saturation are crucial. Endotracheal tube patency should be ensured.

Q9: What is the mechanism of action of Colfosceril Palmitate?

A: It replaces deficient or ineffective surfactant, reducing surface tension in the alveoli, thereby improving lung compliance and gas exchange.

Q10: How should I monitor a neonate receiving Colfosceril Palmitate?

A: Continuous monitoring of heart rate, oxygen saturation, and blood gases is essential. Observe for signs of endotracheal tube obstruction or reflux, and monitor for any respiratory distress.