EpoprostenolRx

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

Adverse Effects
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

Cost: $$$$$

BIBLIOGRAPHY

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