epoprostenol

Contraindicated in:

Hypersensitivity to epoprostenol or similar compounds;
HF due to severe left ventricular systolic dysfunction;
Patients who develop pulmonary edema during dose initiation.

Use Cautiously in:

OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children;
Geri: Dose adjustments may be necessary in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: chest pain, hypotension, tachycardia, bradycardia

Derm: flushing, rash, sweating

GI: abdominal pain, diarrhea, nausea, vomiting

Hemat: bleeding, thrombocytopenia

Local: injection site reactions

MS: jaw pain, myalgia

Neuro: anxiety, dizziness, headache, hypoesthesia/hyperesthesia/paresthesia

Resp: dyspnea, pulmonary edema

Misc: flu-like symptoms

Interactions ⬆ ⬇

Drug-drug:

Additive hypotension may occur with antihypertensives, diuretics, or other vasodilators.
Although concurrent use is common and accepted, risk of bleeding may be ↑ by anticoagulants or other agents affecting platelet function.
May ↑ levels and risk of toxicity of digoxin.

Route/Dosage ⬆ ⬇

IV (Adults ): Initiate at 2 ng/kg/min; may ↑ by 1–2 ng/kg/min every 15 min or longer until adequate clinical response. If dose-limiting adverse effects occur, may ↓ infusion rate in decrements of 2 ng/kg/min at intervals of ≥15 min. Changes in infusion rate should be based on persistence, recurrence, or worsening of symptoms and/or emergence of adverse reactions. Abrupt withdrawal or large ↓ in infusion rate should be avoided.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 0.5 mg/vial; 1.5 mg/vial

Assessment ⬆ ⬇

Monitor hemodynamic parameters (cardiac index, mean pulmonary arterial pressure, pulmonary vascular resistance, total pulmonary resistance, mean systemic arterial pressure) frequently during acute dose ranging and periodically during chronic infusion.
Acute Dose Ranging: Monitor for dose-limiting side effects (nausea, vomiting, headache, hypotension, flushing, chest pain, anxiety, dizziness, bradycardia, dyspnea, abdominal pain, musculoskeletal pain, tachycardia) frequently.
Chronic Infusion: Monitor BP (supine and standing) and HR closely for several hrs after dose adjustments.
- Monitor for headache, jaw pain, flushing, diarrhea, nausea, vomiting, flu-like symptoms, and anxiety. At first sign, recurrence or worsening of pulmonary hypertension, or other side effects, make dose adjustments per above guidelines. Do not abruptly stop epoprostenol.

Lab Test Considerations:

May cause thrombocytopenia.

Implementation ⬆ ⬇

Y-Site Compatibility:
- bivalirudin

IV Administration:

Anticoagulant therapy is usually administered concurrently, unless contraindicated, to ↓ risk of pulmonary or systemic embolism.
- Administer via peripheral infusion during acute dose ranging and by chronic continuous infusion via central venous catheter using a programmable ambulatory infusion pump for chronic administration.
- Use an infusion set with an in-line 0.22-micron filter. The infusion pump should be able to adjust infusion rates in 2 ng/kg/min increments, be accurate to ±6% of the programmed rate, and be positive pressure-driven with intervals between pulses ≤3 min. The reservoir should be made of polyvinyl chloride, polypropylene, or glass.
- Do not mix with other parenteral medications or solutions prior to or during administration.
Continuous Infusion: Reconstitution: For either the 3000- or 5000-ng/mL concentration, dissolve contents of one 0.5-mg vial with 5 mL sterile water or 0.9% NaCl injection. Withdraw 3 mL for the 3000-ng/mL concentration and the entire vial contents for the 5000-ng/mL concentration and add to a sufficient quantity of identical diluent to make a total of 100 mL.Concentration: 3000 or 5000 ng/mL. Reconstitution: For the 10,000-ng/mL concentration, dissolve contents of two 0.5-mg vials each with 5 mL sterile water or 0.9% NaCl injection. Withdraw entire vial contents, and add to a sufficient quantity of identical diluent to make a total of 100 mL.Concentration: 10,000 ng/mL.Diluent: For the 15,000-ng/mL concentration, dissolve contents of a 1.5-mg vial with 5 mL sterile water or 0.9% NaCl injection. Withdraw entire vial contents, and add to a sufficient quantity of identical diluent to make a total of 100 mL. Concentration: 15,000 ng/mL. Diluent: For the 30,000 ng/mL concentration, dissolve contents of two 1.5-mg vials each with 5 mL sterile water or 0.9% NaCl injection. Withdraw entire vial contents, and add to a sufficient quantity of identical diluent to make a total of 100 mL. Concentration: 30,000 ng/mL.
- May require more than one solution strength during acute dose ranging. Usually 3000 and 10,000 ng/mL are used.
- Protect unopened vials and reconstituted solutions from light. Reconstituted solution is stable for 8 hr at room temperature or 48 hr if refrigerated. Do not freeze.
Rate: Infusion rate usually ranges from 2–16 ng/kg/min.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient on reconstitution, administration, and care of permanent central venous catheter.
Advise patient of the importance of continuous therapy; even brief interruptions of the infusion may cause rebound pulmonary hypertension (dyspnea, dizziness, asthenia). Provide patient with access to a backup infusion pump and intravenous infusion sets to prevent potential interruptions in drug delivery.
Inform patient that therapy may be prolonged, possibly lasting yrs.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

ROUTE	ONSET	PEAK	DURATION
IV	rapid (within min)	unknown	2–3 min‡

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇