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Clinical References

Pharmacology

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Learning Center/Pharmacology/Epoprostenol

pulmonary vasodilator

Epoprostenol

Flolan / Veletri

Route: IV (continuous infusion) · inhaled (SVN)
Onset: Minutes (IV); 5–15 minutes (inhaled)
Duration: Half-life: 3–5 minutes IV → continuous infusion required

Mechanism of action

Synthetic prostacyclin (PGI2). Binds prostacyclin receptors on pulmonary vascular smooth muscle → increases cAMP → vasodilation. Also inhibits platelet aggregation.

Dosing

Adult: IV PAH: 1–2 ng/kg/min initial; titrate by 1–2 ng/kg/min q15 min. Inhaled (ARDS): 0.05 mcg/kg/min via nebulizer

Indications

Pulmonary arterial hypertension (WHO Group I)
Inhaled: ARDS (off-label alternative to iNO)
Inhaled: right heart failure with pulmonary hypertension

Contraindications

Congestive heart failure due to severe left ventricular dysfunction
Hypersensitivity to epoprostenol or structurally related compounds

Side effects

Systemic hypotension (IV form — significant)
Headache
Flushing
Jaw pain
Diarrhea/nausea
Thrombocytopenia
Rebound pulmonary hypertension on abrupt discontinuation (life-threatening)

Monitoring parameters

Blood pressure (systemic hypotension with IV)
Pulmonary artery pressures
Platelet count
SpO2
Signs of rebound PH if interrupted

Drug interactions

Anticoagulants/antiplatelets (potentiated bleeding risk)
Antihypertensives (additive hypotension)
Diuretics (additive hypotension)

NBRC high-yield

Synthetic prostacyclin — short half-life (3–5 min); continuous IV or inhaled
Never interrupt — abrupt stop → rebound pulmonary hypertension
Inhaled form: selective pulmonary vasodilation like iNO
IV form causes systemic hypotension
Flolan requires refrigeration; Veletri is room temperature stable

Clinical pearls

Very short half-life (3–5 min) — NEVER interrupt IV infusion (central line mandatory)
Flolan requires ice packs; Veletri is stable at room temperature
Inhaled form avoids systemic hypotension (similar advantage to iNO)
Abrupt discontinuation can cause life-threatening rebound pulmonary hypertension
Patients on IV epoprostenol must have backup supplies and trained caregivers

Mnemonic

Flolan FLOws constantly — half-life 3–5 min, never stop infusion

Epoprostenol (Flolan, Veletri) — Respiratory Pharmacology