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 of digoxin.

Availability ⬆ ⬇

(Generic available)

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

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, infusion rate may be ↓ in decrements of 2 ng/kg/min at intervals of at least 15 min. Changes in infusion rate should be based upon persistence, recurrence, or worsening of symptoms and/or emergence of adverse reactions. Abrupt withdrawal or large reductions in infusion rate should be avoided.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

A prostaglandin that directly dilates pulmonary and systemic arterial vasculature.
Also inhibits platelet aggregation.

Therapeutic effects:

Improved exercise capacity.

Classifications ⬆ ⬇

Therapeutic Classification: vasodilators

Pharmacologic Classification: prostaglandins, vasodilators

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Rapidly and extensively degraded in plasma; some metabolites are pharmacologically active.

Half-Life: ≤6 min.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(hemodynamic effects)

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

‡Following discontinuation.

Patient/Family Teaching ⬆ ⬇

Home Care Issues: Instruct patient on reconstitution, administration, and care of the permanent central venous catheter.
Advise patient of the importance of continuous therapy. Inform patient that even brief interruptions of the infusion may cause symptoms of 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. Also inform patients that therapy may be prolonged, possibly lasting years.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇