Last updated: October 17, 2014
Trade Names: Flolan
Synonyms: Prostacyclin, PGI2
Drug Class: Prostaglandin
Preparations: Injection: 0.5- and 1.5-mg vials
Dose: Administered by a pump as a continuous intravenous infusion through a central line. The usual starting dose is 2 ng/kg/min, and the dose is titrated up depending on clinical response and adverse effects.
Indications: Pulmonary arterial hypertension, pulmonary hypertension associated with connective tissue diseases
Mechanism of Action: Prostacyclin is a potent vasodilator and also decreases platelet aggregation.
Contraindications: Hypersensitivity, heart failure with severe left ventricular systolic dysfunction
Precautions: Sudden discontinuation of drug can cause rebound pulmonary hypertension. Initiation requires specialized cardiopulmonary monitoring and expertise.
Monitoring: Monitor closely for clinical response, adverse effects, pump dysfunction, status of central line and adherence to therapy.
Pregnancy Risk: B
Common: Flushing, tachycardia, GI side effects (nausea, vomiting, diarrhea, cramps), dizziness, headache, jaw pain, tremor
Less common: Hypotension, syncope, angina, edema, rash, anemia, central line infection
Drug Interactions: May potentiate the hypotensive effects of other vasodilators or antihypertensive drugs
Patient Instructions: Therapy requires care of a central line, wearing a pump, and self-administration of drug. Dose titration is required. Do not discontinue the drug suddenly.
Comments: Epoprostenol is only prescribed by physicians expert in the management of pulmonary hypertension, generally cardiologists or pulmonologists with a special interest in pulmonary hypertension. In clinical trials, the 6-minute walk distance improved in patients with scleroderma with pulmonary hypertension treated with epoprostenol. There are reports of digital ulcers or digital ischemia improving.
Clinical Pharmacology: Rapidly hydrolyzed in blood, half-life 5 minutes
Badesch DB, Tapson VF, McGoon MD, et al. Continuous intravenous epoprostenol for pulmonary hypertension due to the scleroderma spectrum of disease. A randomized, controlled trial. Ann Intern Med 2000;132:425–434. PMID:10733441
Galiè N, Corris PA, Frost A, et al. Updated treatment algorithm of pulmonary arterial hypertension. J Am Coll Cardiol 2013;62(25 Suppl):D60-72. PMID: 24355643