Epoprostenol

FLOLAN

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Epoprostenol ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Epoprostenol ballicule

What it isProstacyclin IP-receptor agonist given by continuous IV infusion; pulmonary arterial hypertension.

Why this oneProvides rapid, potent pulmonary vasodilation with established survival benefit in severe disease.

What limits itAny infusion interruption can trigger fatal rebound pulmonary hypertension; central-line infection and high-output symptoms complicate use.

Epoprostenol molecular structure (skeletal formula) — Molecular structure: Epoprostenol

FDA-approved for

pulmonary arterial hypertension (1995)

Principal riskabrupt infusion interruption causing fatal rebound pulmonary hypertension

Classes and tags

Clinical profile

Therapeutic safety burden4 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryUnknown / historical label unavailable

Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

Dosing under review against the product label.

Available strengths

inj 0.5, 1.5 mg

Contraindications

Chronic use in congestive heart failure due to severe left ventricular systolic dysfunction
Pulmonary edema developing during dose initiation (possible pulmonary veno-occlusive disease) — do not use chronically

Cautions

Potent pulmonary/systemic vasodilator — initiate with monitoring and emergency care available
Rebound pulmonary hypertension with even brief infusion interruptions
Catheter-related bloodstream infection / sepsis risk

Adverse reactions

Initiation/escalation: nausea, vomiting, headache, hypotension, flushing, chest pain, anxiety, dizziness, bradycardia
Chronic: jaw pain, flushing, diarrhea, flu-like symptoms, headache, anxiety

Pregnancy Limited data show no established drug-associated risk; untreated PAH poses maternal/fetal risk.

Lactation Undefined

Cost

Epoprostenol (FLOLAN)

Strength		#/mo	generic $/unit	CostPlus
0.5 mg	inj	per unit		not offered
1.5 mg	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Epoprostenol is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry2008

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Self-check

What can interrupting epoprostenol cause?
Fatal rebound pulmonary hypertension.
How is epoprostenol delivered?
Continuous IV infusion.