Epoprostenol sodium
Epoprostenol sodium (Flolan)
Epoprostenol sodium
(eh-poh- PROST-en-ohl)
Pregnancy Category: B Flolan (Rx)

Classification: Antihypertensive, miscellaneous

See Also: See also Antihypertensive Agents .

Action/Kinetics: Acts by direct vasodilation of pulmonary and systemic arterial vascular beds and by inhibition of platelet aggregation. IV infusion in clients with pulmonary hypertension results in increases in cardiac index and SV and decreases in pulmonary vascular resistance, total pulmonary resistance, and mean systemic arterial pressure. Is rapidly hydrolyzed at the neutral pH of the blood as well as by enzymatic degradation. Metabolites are less active than the parent compound. t 1/2: 6 min.

Uses: Long-term IV treatment of primary pulmonary hypertension in New York Heart Association Class III and Class IV clients.

Contraindications: Chronic use in those with CHF due to severe LV systolic dysfunction and in those who develop pulmonary edema during dose ranging.

Special Concerns: Abrupt withdrawal or sudden large decreases in the dose may cause rebound pulmonary hypertension. Use caution in dose selection in the elderly due to the greater frequency of decreased hepatic, renal, or cardiac function, as well as concomitant disease or other drug therapy. Use with caution during lactation. Safety and efficacy have not been determined in children.

Side Effects: Side effects have been classified as those occurring during acute dose ranging, those as a result of the drug delivery system, and those occurring during chronic dosing.
Those occurring during acute dose ranging. CV: Flushing, hypotension, bradycardia, tachycardia. GI: N&V;, abdominal pain, dyspepsia. CNS: Headache, anxiety, nervousness, agitation, dizziness, hypesthesia, paresthesia. Miscellaneous: Chest pain, musculoskeletal pain, dyspnea, back pain, sweating.
Those occurring as a result of the drug delivery system. Due to the chronic indwelling catheter: Local infection, pain at the injection site, sepsis, infections.
Those occurring during chronic dosing. CV: Flushing, tachycardia. GI: N&V;, diarrhea. CNS: Headache, anxiety, nervousness, tremor, dizziness, hypesthesia, hyperesthesia, paresthesia. Musculoskeletal: Jaw pain, myalgia, nonspecific musculoskeletal pain. Miscellaneous: Flu-like symptoms, chills, fever, sepsis.

Overdose Management: Symptoms: Flushing, headache, hypotension, tachycardia, nausea, vomiting, diarrhea. Treatment: Reduce dose of epoprostenol.

Drug Interactions: Anticoagulants / Possible risk of bleeding Antiplatelet drugs / Possible risk of bleeding Diuretics / Additional in BP Vasodilators / Additional in BP

How Supplied: Powder for injection: 0.5 mg, 1.5 mg

Dosage
?Chronic IV Infusion Pulmonary hypertension.
Acute dose ranging: The initial chronic infusion rate is first determined. The mean maximum dose that did not elicit dose-limiting pharmacologic effects was 8.6 ng/kg/min. Continuous chronic infusion, initial: 4 ng/kg/min less than the maximum-tolerated infusion rate determined during acute dose ranging. If the maximum-tolerated infusion rate is less than 5 ng/kg/min, start the chronic infusion at one-half the maximum-tolerated infusion rate. Dosage adjustments: Changes in the chronic infusion rate are based on persistence, recurrence, or worsening of the symptoms of primary pulmonary hypertension. If symptoms require an increase in infusion rate, increase by 1-2 ng/kg/min at intervals (at least 15 min) sufficient to allow assessment of the clinical response. If a decrease in infusion rate is necessary, gradually make 2-ng/kg/min decrements every 15 min or longer until the dose-limiting effects resolve. Avoid abrupt withdrawal or sudden large reductions in infusion rates.