Epoprostenol

DEA Class; Rx

Common Brand Names; Flolan, Veletri

• PAH, Prostacyclin Analogs

Hypersensitivity to epoprostenol

Chronic use in patients with CHF due to left ventricular systolic dysfunction

Development of pulmonary edema during initial dose titration

• Flushing (58%)
• Jaw pain (54%)
• Headache (49%)
• Myalgia (44%)
• Diarrhea (37%)
• Nausea (32%)
• Vomiting (32%)
• Flu-like symptoms (25%)
• Eczema (25%)
• Rash (25%)
• Urticaria (25%)
• Hypotension (16%)
• Anxiety (11%)
• Nervousness (11%)
• Musculoskeletal pain (2%)
• Hyperesthesia (1%)
• Tachycardia (1%)

Initiate therapy in a setting with adequate personnel and equipment for physiologic monitoring and emergency care; dose initiation has been performed during right heart catheterization and without cardiac catheterization; during dose initiation, asymptomatic increases in pulmonary artery pressure coincident with increases in cardiac output reported rarely; in such cases, consider dose reduction, but such an increase does not imply that chronic treatment is contraindicated

Abrupt withdrawal (including interruptions in drug delivery) or sudden large reductions in dosage may result in symptoms associated with rebound pulmonary hypertension, including dyspnea, dizziness, and asthenia; in clinical trials, death attributable to interruption of therapy reported; avoid abrupt withdrawal

Use caution in patients with risk factors of bleeding

Serious blood stream infectiosn may develop from chronic infusions requiring an indwelling central venous catherer

Asymptomatic increase in pulmonary artery pressure

Some patients may develop pulmonary edema during dosing adjustments

Limited published data from case series and case reports have not established an association with therapy and major birth defects, miscarriage or adverse maternal or fetal outcomes when treatment is used during pregnancy

There are no data on presence of epoprostenol in either human or animal milk, effects on breastfed infant, or on milk production