epoprostenol (Rx)

Brand and Other Names:Flolan, Veletri
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable, powder for reconstitution

  • 0.5mg/vial
  • 1.5mg/vial
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Pulmonary Hypertension

Initial: 2 ng/kg/min IV infusion pump over 24-48 hours; may initiate at lower dose if intolerant to starting dose 

Titrate by 1-2 ng/kg/min q15min or longer, until desired effect or dose-limiting pharmacologic effects occur

Dosage Forms & Strengths

injectable, powder for reconstitution

  • 0.5 mg
  • 1.5 mg
more...

Pulmonary Hypertension (Off-label)

Initial 2 ng/kg/min IV infusion pump over 24-48 hours initially; may initiate at lower dose if intolerant to starting dose 

Titrate by 1-2 ng/kg/min IV q15min or longer, until desired effect or dose-limiting pharmacologic effects occur

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Interactions

Interaction Checker

and epoprostenol

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Flushing (58%)

            Jaw pain (54%)

            Headache (49%)

            Myalgia (44%)

            Diarrhea (37%)

            Nausea (32%)

            Vomiting (32%)

            Flu-like symptoms (25%)

            Eczema (25%)

            Rash (25%)

            Urticaria (25%)

            Hypotension (16%)

            Anxiety (11%)

            Nervousness (11%)

            1-10%

            Musculoskeletal pain (2%)

            Hyperesthesia (1%)

            Tachycardia (1%)

            Frequency Not Defined

            Hemorrhage

            Thrombocytopenia

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            Warnings

            Contraindications

            Hypersensitivity to epoprostenol

            Chronic use in patients with CHF due to left ventricular systolic dysfunction

            Development of pulmonary edema during initial dose titration

            Cautions

            Patients receiving epoprostenol should receive anticoagulant treatment (unless contraindicated) to decrease the risk of pulmonary thromboembolism or systemic embolism

            Use caution in patients with risk factors of bleeding

            Serious blood stream infectiosn may develop from chronic infusions requiring an indwelling central venous catherer

            Asymptomatic increase in pulmonary artery pressure

            Once initiated, duration of IV epoprostenol may be needed for years

            Some patients may develop pulmonary edema during dosing adjustments

            Rebound pulmonary hypertension may occur with abrupt interruptions or sudden reductions

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Excretion in milk unknown; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Potent peripheral vasodilator of all vascular beds; also prevents platelet aggregation

            Pharmacokinetics

            Half-life: 3-6 min

            Metabolism: rapidly hydrolyzed in blood to metabolites

            Metabolite: 6-keto-prostaglandin F1-alpha (inactive), dihydro-prostaglandin F1-alpha metabolites (unknown activity)

            Excretion: Urine (84%); feces (4%)

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            Administration

            IV Preparation

            Flolan

            • 3000 ng/mL: 0.5 mg vial/5 mL mfr supplied sterile diluent; withdraw 3 mL; and add sufficient diluent to make 100 mL
            • 5000 ng/mL: 0.5 mg vial/5 mL mfr supplied sterile diluent; withdraw entire vial; and add sufficient diluent to make 100 mL
            • 10,000 ng/mL: two 0.5 mg vials each in 5 mL mfr supplied sterile diluent; withdraw entire vial; and add sufficient diluent to make 100 mL
            • 15,000 ng/mL: 1.5 mg vial/5 mL mfr supplied sterile diluent; withdraw entire vial; and add sufficient diluent to make 100 mL

            Veletri

            • Reconstituted in vial with only 5 mL of either sterile water for injection or 0.9% NaCl
            • Further dilute reconstituted product with same diluent used for reconstitution
            • Solutions of 15,000 ng/mL or above may be used for up to 25 hr at room temperature
            • Lower concentrations may be used with pump reservoir changed q12hr at room temperature

            IV Administration

            Continuous IV infusion via central venous catheter using ambulatory infusion pump

            Do not mix with any other parenteral medications or solutions prior or during administration

            During treatment initiation, may be administered peripherally

            Storage

            Flolan

            • Unopened vials are stable until date indicated on package when stored at room temperature (25 degrees C [77 degrees F]) in carton and protected from light
            • Reconstituted vial: May be refrigerated (2-8 degrees C [36-46 degrees F]) for up to 48 hr
            • Room temperature administration: When administered at room temperature, reconstituted solutions may be used for no longer than 8 hr
            • Use with cold packs: May be administered for up to 24 hr with cold packs (change cold packs q12hr during infusion)
            • Do not freeze
            • Do not expose to direct sunlight

            Veletri

            • Unopened vials are stable until date indicated on package when stored at room temperature (25 degrees C [77 degrees F]) in carton and protected from light
            • Reconstituted vial: May be refrigerated (2-8 degrees C [36-46 degrees F]) for as long as 5 days or held at up to 25 degrees C (77 degrees F) for up to 48 hr prior to use
            • Final solutions of 15,000 ng/mL or above are stable at room temperature (25 degrees C) for up to 24 hr
            • Less concentrated final solutions should be used for only 12 hr
            • Cold packs are not needed during administration
            • Do not freeze
            • Do not expose to direct sunlight
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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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