Epoprostenol
FLOLAN
What it isProstacyclin IP-receptor agonist given by continuous IV infusion; pulmonary arterial hypertension.
Why this oneIt provides 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.
FDA-approved for
- pulmonary arterial hypertension (1995)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Pulmonary arterial hypertension | adult | Continuous IV infusion 2 ng/kg/min | Titrate up by 2 ng/kg/min q>=15 min to dose-limiting effect / tolerance | Individualized to tolerability |
Titration Increase by 1–2 ng/kg/min at intervals of at least 15 min based on clinical response.
Renal Undefined
Hepatic Undefined
Instructions
- Continuous IV infusion via central venous catheter using an ambulatory pump
- Reconstitute only as directed (Sterile Water or 0.9% NaCl); do not dilute or mix with other solutions/medications
- Do not abruptly lower the dose or withdraw (rebound pulmonary hypertension)
- Give anticoagulant therapy unless contraindicated; use aseptic technique
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
NO BOXED WARNINGS
Principal riskabrupt infusion interruption causing fatal rebound pulmonary hypertension
Cost, est. cash$1,000–$20,000/month
Generic entry2008
Classes and tags
Clinical profile
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.
Mechanism of action: Epoprostenol ballicule
