Pulmonary Surfactant (Medication)

From Mdwiki
Pulmonary surfactant
Beractant, surrounded by devices for its application.
Names
PronunciationCurosurf, Survanta, others
Other namesBeractant, Poractant alfa, others
Clinical data
Defined daily dosenot established[1]
External links
AHFS/Drugs.comMonograph
Legal
License data


Pulmonary surfactant is used as a medication to treat and prevent respiratory distress syndrome in newborn babies.[2] Prevention is generally done in babies born at a gestational age of less than 32 weeks.[2] It is given by the endotracheal tube.[2] Onset of effects is rapid.[3] A number of doses may be needed.[3]

Side effects may include slow heart rate and low oxygen levels.[2] Its use is also linked with intracranial bleeding.[2] Pulmonary surfactant may be isolated from the lungs of cows or pigs or made artificially.[2][4][5]

Pulmonary surfactant was discovered in the 1950s and a manufactured version was approved for medical use in the United States in 1990.[4] It is on the World Health Organization's List of Essential Medicines.[6] In the United Kingdom it costs the NHS 281.64 to 547.40 pounds per dose.[2]

Medical uses[edit | edit source]

Pulmonary surfactant is used to treat and prevent respiratory distress syndrome in newborn babies.[2] Prevention is generally done in babies born less than 32 weeks gestational age.[2] Tentative evidence supports use in drowning.[7]

Dosage[edit | edit source]

The defined daily dose is not established.[1]

Types[edit | edit source]

See also: Pulmonary surfactant § composition

There are a number of types of pulmonary surfactants available. Like their natural counterparts, pulmonary surfactant preparations consist of phospholipids (mainly DPPC) combined with spreading agents such as SP-B and SP-C.[8]

Synthetic pulmonary surfactants:

  • Colfosceril palmitate (Exosurf) - a mixture of DPPC with hexadecanol and tyloxapol added as spreading agents
  • Pumactant (Artificial Lung Expanding Compound or ALEC) - a mixture of DPPC and PG
  • Lucinactant (KL-4) - composed of DPPC, palmitoyl-oleoyl phosphatidylglycerol, and palmitic acid, combined with a 21 amino acid synthetic peptide (sinapultide) that mimics the C-terminal helical domain of SP-B.[9]
  • Venticute - DPPC, PG, palmitic acid and recombinant SP-C
  • Lucinactant (trade name Surfaxin) is a liquid medication that contains DPPC, POPG as the sodium salt, and palmitic acid.

Animal derived surfactants:

  • Beractant
    • (Alveofact) - extracted from cow lung lavage fluid, manufacturing by Boehringer Ingelheim
    • (Survanta) - extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufacturing by Abbvie
    • (Beraksurf) - extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufacturing by Tekzima
  • Calfactant (Infasurf) - extracted from calf lung lavage fluid
  • Poractant alfa (Curosurf) - extracted from material derived from minced pig lung

History[edit | edit source]

Researcher John Clements identified surfactants and their role in the 1950s. Mary Ellen Avery soon after showed that the lungs of premature infants couldn't produce surfactants.[10]

Exosurf, Curosurf, Infasurf, and Survanta were the initial surfactants FDA approved for use in the U.S.[11]

In 2012, the US FDA approved an additional synthetic surfactant, lucinactant (Surfaxin).[citation needed]

References[edit | edit source]

  1. ↑ 1.0 1.1 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 1 July 2021. Retrieved 15 September 2020.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 217. ISBN 9780857111562.
  3. ↑ 3.0 3.1 Fanaroff, Avroy A.; Fanaroff, Jonathan M. (2013). Klaus and Fanaroff's Care of the High-Risk Neonate, Expert Consult - Online and Print,6: Klaus and Fanaroff's Care of the High-Risk Neonate. Elsevier Health Sciences. p. 252. ISBN 1416040013. Archived from the original on 2017-01-09.
  4. ↑ 4.0 4.1 Lantos, John D.; Meadow, William L. (2006). Neonatal Bioethics: The Moral Challenges of Medical Innovation. JHU Press. pp. 54–56. ISBN 9780801883446. Archived from the original on 2017-01-09.
  5. ↑ Slonim, Anthony D.; Pollack, Murray M. (2006). Pediatric Critical Care Medicine. Lippincott Williams & Wilkins. pp. 724–725. ISBN 9780781794695. Archived from the original on 2017-01-09.
  6. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  7. ↑ Brady, Bill; Charlton, Nathan P.; Lawner, Benjamin J.; Sutherland, Sara F. (2012). Cardiac Arrest, An Issue of Emergency Medicine Clinics. Elsevier Health Sciences. p. 175. ISBN 1455742767. Archived from the original on 2017-01-09.
  8. ↑ Nkadi, Paul O.; Merritt, T. Allen; Pillers, De-Ann M. (2009). "An overview of pulmonary surfactant in the neonate: Genetics, metabolism, and the role of surfactant in health and disease". Molecular Genetics and Metabolism. 97 (2): 95–101. doi:10.1016/j.ymgme.2009.01.015. ISSN 1096-7192. PMC 2880575. PMID 19299177.
  9. ↑ "KL4 Surfactant Technology - Windtree Therapeutics, Inc". Windtree Therapeutics, Inc. Archived from the original on July 29, 2018. Retrieved 29 November 2017.
  10. ↑ Palca, Joe (3 August 2015). "How A Scientist's Slick Discovery Helped Save Preemies' Lives". NPR. Archived from the original on 3 August 2015. Retrieved 3 August 2015.
  11. ↑ Taeusch, H William; Lu, Karen; Ramierez-Schrempp, Daniela (2002). "Improving pulmonary surfactants" (PDF). Acta Pharmacologica Sinica. 23 Suppl: 11–5. Archived (PDF) from the original on 2015-03-01.

External links[edit | edit source]

Identifiers:
  • "Poractant alfa". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 2019-12-31. Retrieved 2019-12-31.
  • "Beractant". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 2019-12-31. Retrieved 2019-12-31.
  • "Calfactant". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 2019-12-31. Retrieved 2019-12-31.

Categories: [World Health Organization essential medicines] [RTT]

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