EPOPROSTENOL SODIUM

(e-po-pros'te-nol)

Flolan
Classifications: prostaglandin; antihypertensive;
Therapeutic: pulmonary antihypertensive
Pregnancy Category: B

Availability

0.5 mg, 1.5 mg powder for injection

Action

Naturally occurring prostaglandin that reduces right and left ventricular afterload, increases cardiac output, and increases stroke volume through its vasodilation effect. May also decrease pulmonary vascular resistance and mean systemic arterial pressure, depending on the dose. Potent pulmonary vasodilator that reduces pulmonary hypertension.

Therapeutic Effect

Potent vasodilator of pulmonary and systemic arterial vascular beds and an inhibitor of platelet aggregation.

Uses

Long-term treatment of primary pulmonary hypertension in NYHA Class III and IV patients.

Contraindications

Chronic use with left ventricular systolic dysfunction in CHF patients, hypersensitivity to epoprostenol or related compounds.

Cautious Use

Older adults, pregnancy (category B), concurrent use of hypotensive drugs. Safety and efficacy in children are not established.

Route & Dosage

Primary Pulmonary Hypertension
Adult: IV Acute dose, Initiate with 2 ng/kg/min, increase by 2 ng/kg/min q15 min until dose-limiting effects occur (e.g., nausea, vomiting, headache, hypotension, flushing); Chronic administration, Start infusion at 4 ng/kg/min less than the maximum tolerated infusion; if maximum tolerated infusion is ?5 ng/kg/min, start maintenance infusion at 50% of maximum tolerated dose

Administration

Note: Anticoagulation therapy is generally initiated along with epoprostenol to reduce the risk of developing thromboembolic disease.

Intravenous

PREPARE: Continuous: Must be reconstituted using sterile diluent for epoprostenol; must not be mixed with any other medications or solution prior to or during administration. To make 100 mL of 3000 ng/mL, add 5 mL of diluent to one 0.5 mg vial; withdraw 3 mL and add to enough diluent to make a total of 100 mL. To make 100 mL of 5000 ng/mL, add 5 mL of diluent to one 0.5 mg vial; withdraw contents of vial and add to enough diluent to make a total of 100 mL. To make 100 mL of 10,000 ng/mL, add 5 mL of diluent to each of two 0.5 mg vials; withdraw contents of each vial and add to enough diluent to make a total of 100 mL. To make 100 mL of 15,000 ng/mL, add 5 mL of diluent to a 1.5 mg vial; withdraw contents of vial and add to enough diluent to make a total of 100 mL.

ADMINISTER: Continuous: Give at ordered rate using an infusion control device. Avoid abrupt infusion interruption or large dosage reduction.

INCOMPATIBILITIES Solution/additive: Do not mix or infuse with any other drugs.

Store unopened vials at 15°–25° C (59°–77° F). Protect from light. See manufacturer's directions for stability or storage of reconstituted solutions.

Adverse Effects (≥1%)

CNS: Chills, fever, flu-like syndrome, dizziness, syncope, headache, anxiety/nervousness, hyperesthesia, paresthesia, dizziness. CV: Tachycardia, hypotension, flushing, chest pain, bradycardia. GI: Diarrhea, nausea, vomiting, abdominal pain. Musculoskeletal: Jaw pain, myalgia, nonspecific musculoskeletal pain. Respiratory: Dyspnea. Other: Dose-limiting effects.

Interactions

Drug: Hypotension if administered with other vasodilators or antihypertensives.

Pharmacokinetics

Peak: Approximately 15 min. Metabolism: Rapidly hydrolyzed at neutral pH in blood; also subject to enzyme degradation. Elimination: 82% in urine. Half-Life: Approximately 6 min.

Nursing Implications

Assessment & Drug Effects

Assess carefully for development of pulmonary edema during dose ranging.
Monitor respiratory and cardiovascular status frequently during entire period of chronic use of epoprostenol.
Monitor for and report recurrence or worsening of symptoms associated with primary pulmonary hypertension (e.g., dyspnea, dizziness, exercise intolerance) or adverse effects of drug; dosage adjustments may be needed.

Patient & Family Education

Learn correct techniques for storage, reconstitution, and administration of drug, and maintenance of catheter site (see ADMINISTRATION).
Notify physician immediately of S&S of worsening primary pulmonary hypertension, adverse drug reactions, and S&S of infection at catheter site or sepsis.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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