Aviptadil Infusion Protocol
The recommended protocol for Aviptadil infusion is a daily 12-hour infusion for 3 days, with escalating doses of 600 pmol/kg on day 1,1200 pmol/kg on day 2, and 1800 pmol/kg on day 3. 1
Administration Guidelines
- Aviptadil should be administered as an intravenous infusion through a central line whenever possible to minimize the risk of extravasation 2
- The infusion should be given over a 12-hour period each day for 3 consecutive days 1
- Dosing follows an escalation pattern:
- Day 1: 600 pmol/kg over 12 hours
- Day 2: 1200 pmol/kg over 12 hours
- Day 3: 1800 pmol/kg over 12 hours 1
Monitoring Requirements
- Continuous electrocardiographic monitoring should be employed during the infusion to detect any cardiac adverse effects 2
- Regular monitoring of oxygen saturation, respiratory parameters (including PaO2/FiO2 ratio), and hemodynamic stability is essential 3
- Monitor for potential adverse effects including:
- Hypotension
- Cardiac arrhythmias
- Tissue necrosis if extravasation occurs 2
Preparation and Compatibility
- Aviptadil should not be mixed with alkaline solutions as this may inactivate the drug 2
- Use proper infusion systems to ensure accurate dosing, as both therapeutic effectiveness and adverse events are dose and rate dependent 2
- Standard drip concentrations should be used rather than "rule of 6" calculations to reduce medication errors 2
Special Considerations
- If extravasation occurs, infiltrate the site with 5-10 mg of phentolamine diluted in 10-15 mL of saline as soon as possible to prevent tissue necrosis 2
- A defibrillator should be immediately available during administration due to potential cardiac effects 2
- In patients with renal impairment, dose adjustments may be necessary, similar to other vasoactive medications 2
Clinical Evidence
- Recent clinical trials have shown that Aviptadil may improve survival in patients with COVID-19-related respiratory failure, though results have been mixed 4
- A 2022 study showed a statistically significant two-fold improvement in survival odds at 60 days in patients with COVID-19 respiratory failure treated with Aviptadil compared to placebo 4
- A smaller retrospective study demonstrated improvements in oxygen saturation, PaO2/FiO2 ratio, and radiological clearance in patients with viral-related ARDS after Aviptadil administration 3
- However, a larger 2023 randomized controlled trial (TESICO) did not show significant improvement in clinical outcomes up to day 90 when compared with placebo 1
Common Pitfalls and Caveats
- Ensure proper vascular access before initiating infusion, preferably through a central line to minimize risk of extravasation 2
- Do not administer as a rapid bolus; the 12-hour infusion period is designed to optimize therapeutic effect while minimizing adverse events 1
- Be prepared to manage potential hypotension by having vasopressors readily available 2
- The safety profile appears acceptable with no significant drug-related serious adverse events reported in clinical trials, but vigilant monitoring remains essential 4