Home Drug Guide Epoprostenol Sodium

Drug Guide

Generic Name

Epoprostenol Sodium

Brand Names Flolan, Veletri

Classification

Therapeutic: Antiplatelet agent; Vasodilator

Pharmacological: Prostacyclin (PGI2) analog)

FDA Approved Indications

Pulmonary arterial hypertension (WHO Group 1)

Mechanism of Action

Epoprostenol is a prostacyclin (PGI2) analog that causes vasodilation and inhibits platelet aggregation by stimulating adenylate cyclase, increasing cyclic AMP levels in platelets and vascular smooth muscle cells.

Dosage and Administration

Adult: Initial dose: 2.5-5 ng/kg/min IV continuous infusion, titrated based on response and tolerability.

Pediatric: Use based on weight and clinical response; consult specific guidelines.

Geriatric: Adjust dose carefully, considering co-morbidities and concurrent medications.

Renal Impairment: No specific adjustment necessary, but monitor closely.

Hepatic Impairment: Data limited; use with caution.

Pharmacokinetics

Absorption: Given IV infusion, bypassing absorption processes.

Distribution: Widely distributed; high affinity for blood components.

Metabolism: Rapidly cleared via hydrolysis and oxidation; no significant hepatic metabolism.

Excretion: Primarily eliminated in urine as metabolites.

Half Life: Approximately 3-6 minutes.

Contraindications

Allergy to prostacyclins or any component of the formulation.
Severe hypotension.

Precautions

Use with caution in patients with heart failure, recent or ongoing hemorrhage, or compromised hepatic or renal function.
May cause hypotension, flushing, jaw pain, and headache.

Adverse Reactions - Common

Headache (Frequent)
Nausea, vomiting (Common)
Flushing (Common)
Jaw pain (Common)

Adverse Reactions - Serious

Hypotension (Uncommon)
Severe hypotension leading to ischemia (Rare)
Infusion site reactions, thrombosis (Uncommon)

Drug-Drug Interactions

Sympathomimetics (may enhance hypotension)
Other vasodilators (additive effect).

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, oxygenation, infusion site for thrombosis or infiltration.

Diagnoses:

Risk for bleeding
Ineffective tissue perfusion due to hypotension

Implementation: Ensure correct infusion rate, monitor for adverse reactions, support airway and oxygenation, maintain infusion equipment.

Evaluation: Assess improvement in pulmonary hypertension symptoms, monitor for infusion-related adverse effects.

Patient/Family Teaching

Report signs of bleeding, severe hypotension, or infusion site issues.
Do not stop or adjust dose without medical advice.
Understand the importance of continuous infusion and the potential need for hospital or specialized infusion services.

Special Considerations

Black Box Warnings:

Potential for sudden death if interrupted or stopped abruptly (Veletri).

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Hypotension, headache, flushing, nausea.

Treatment: Supportive care with vasopressors and fluid management; discontinue infusion.

Storage and Handling

Storage: Refrigerate at 2°C to 8°C (36°F to 46°F). Do not freeze.

Stability: Stable when refrigerated; Veletri formulation may have different stability profile — consult specific product labeling.