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

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

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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            Contraindicated (0)

              Serious - Use Alternative (1)

              • lofexidine

                lofexidine, epoprostenol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              Monitor Closely (86)

              • aceclofenac

                aceclofenac and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • acemetacin

                acemetacin and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • agrimony

                agrimony and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • aldesleukin

                aldesleukin increases effects of epoprostenol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • alfalfa

                alfalfa and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • alteplase

                alteplase and epoprostenol both increase anticoagulation. Use Caution/Monitor. Coadministration can increase the risk of bleeding, although this did not occur in clinical trials.

              • American ginseng

                American ginseng and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • amifostine

                amifostine, epoprostenol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • antithrombin alfa

                antithrombin alfa and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • antithrombin III

                antithrombin III and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • argatroban

                argatroban and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • aspirin

                aspirin and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • aspirin rectal

                aspirin rectal and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • bemiparin

                bemiparin and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • benazepril

                epoprostenol, benazepril. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

              • bivalirudin

                bivalirudin and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • captopril

                epoprostenol, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

              • carbidopa

                carbidopa increases effects of epoprostenol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              • celecoxib

                celecoxib and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • cinnamon

                cinnamon and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • cordyceps

                cordyceps and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • dabigatran

                dabigatran and epoprostenol both increase anticoagulation. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

              • dalteparin

                dalteparin and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • diclofenac

                diclofenac and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • diflunisal

                diflunisal and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • digoxin

                epoprostenol will increase the level or effect of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and reduce digoxin dose as necessary

              • dong quai

                dong quai and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • eluxadoline

                eluxadoline increases levels of epoprostenol by decreasing metabolism. Use Caution/Monitor. Eluxadoline may increase the systemic exposure of coadministered OATP1B1 substrates.

              • enoxaparin

                enoxaparin and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • etodolac

                etodolac and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • fennel

                epoprostenol and fennel both increase anticoagulation. Use Caution/Monitor.

              • fenoldopam

                epoprostenol, fenoldopam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • fenoprofen

                fenoprofen and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • feverfew

                epoprostenol and feverfew both increase anticoagulation. Use Caution/Monitor.

              • fish oil triglycerides

                fish oil triglycerides will increase the level or effect of epoprostenol by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

              • flurbiprofen

                flurbiprofen and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • fondaparinux

                fondaparinux and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • forskolin

                epoprostenol and forskolin both increase anticoagulation. Use Caution/Monitor.

              • garlic

                epoprostenol and garlic both increase anticoagulation. Use Caution/Monitor.

              • ginger

                epoprostenol and ginger both increase anticoagulation. Use Caution/Monitor.

              • ginkgo biloba

                epoprostenol and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

              • heparin

                heparin and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • horse chestnut seed

                epoprostenol and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.

              • hydralazine

                epoprostenol, hydralazine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • ibrutinib

                ibrutinib will increase the level or effect of epoprostenol by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

              • ibuprofen

                ibuprofen and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • ibuprofen IV

                ibuprofen IV and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • iloprost

                epoprostenol, iloprost. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • indomethacin

                indomethacin and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • ketoprofen

                ketoprofen and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • ketorolac

                ketorolac and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • ketorolac intranasal

                ketorolac intranasal and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • levodopa

                levodopa increases effects of epoprostenol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              • lornoxicam

                lornoxicam and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • meclofenamate

                meclofenamate and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • mefenamic acid

                mefenamic acid and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • meloxicam

                meloxicam and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • minoxidil

                epoprostenol, minoxidil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • mistletoe

                epoprostenol increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nabumetone

                nabumetone and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • naproxen

                naproxen and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • nettle

                epoprostenol increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxaprozin

                oxaprozin and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • panax ginseng

                epoprostenol and panax ginseng both increase anticoagulation. Use Caution/Monitor.

              • parecoxib

                parecoxib and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • pau d'arco

                epoprostenol and pau d'arco both increase anticoagulation. Use Caution/Monitor.

              • phenindione

                phenindione and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • phytoestrogens

                epoprostenol and phytoestrogens both increase anticoagulation. Use Caution/Monitor.

              • piroxicam

                piroxicam and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • protamine

                protamine and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • reishi

                epoprostenol and reishi both increase anticoagulation. Use Caution/Monitor.

              • reteplase

                reteplase and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • salicylates (non-asa)

                salicylates (non-asa) and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • salsalate

                salsalate and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • Siberian ginseng

                epoprostenol and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.

              • sildenafil

                epoprostenol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.

              • sulfasalazine

                sulfasalazine and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • sulindac

                sulindac and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • tenecteplase

                tenecteplase and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • tolfenamic acid

                tolfenamic acid and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • tolmetin

                tolmetin and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • treprostinil

                epoprostenol, treprostinil. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • warfarin

                warfarin and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

              • xipamide

                xipamide increases effects of epoprostenol by pharmacodynamic synergism. Use Caution/Monitor.

              Minor (28)

              • agrimony

                agrimony increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown.

              • amiloride

                epoprostenol increases effects of amiloride by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • anamu

                anamu and epoprostenol both increase anticoagulation. Minor/Significance Unknown.

              • bendroflumethiazide

                epoprostenol increases effects of bendroflumethiazide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • brimonidine

                brimonidine increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown.

              • bumetanide

                epoprostenol increases effects of bumetanide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • chlorothiazide

                epoprostenol increases effects of chlorothiazide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • chlorthalidone

                epoprostenol increases effects of chlorthalidone by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • cornsilk

                cornsilk increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown.

              • cyclopenthiazide

                epoprostenol increases effects of cyclopenthiazide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • danshen

                danshen and epoprostenol both increase anticoagulation. Minor/Significance Unknown.

              • devil's claw

                devil's claw and epoprostenol both increase anticoagulation. Minor/Significance Unknown.

              • drospirenone

                epoprostenol increases effects of drospirenone by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • ethacrynic acid

                epoprostenol increases effects of ethacrynic acid by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • forskolin

                forskolin increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown.

              • furosemide

                epoprostenol increases effects of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • hydrochlorothiazide

                epoprostenol increases effects of hydrochlorothiazide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • indapamide

                epoprostenol increases effects of indapamide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • maitake

                maitake increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown. Maitake mushroom has anti-tumor effects (animal/in vitro research).

              • methyclothiazide

                epoprostenol increases effects of methyclothiazide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • metolazone

                epoprostenol increases effects of metolazone by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • reishi

                reishi increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown.

              • shepherd's purse

                shepherd's purse, epoprostenol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

              • spironolactone

                epoprostenol increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • tizanidine

                tizanidine increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • torsemide

                epoprostenol increases effects of torsemide by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • treprostinil

                treprostinil increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown.

              • triamterene

                epoprostenol increases effects of triamterene by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

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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

              Postmarketing Reports

              Blood and lymphatic: Anemia, hypersplenism, pancytopenia, splenomegaly, thrombocytopenia

              Endocrine and Metabolic: Hyperthyroidism

              Gastrointestinal: Hepatic failure

              Respiratory, Thoracic, and Mediastinal: Pulmonary embolism

              Cardiovascular: High output cardiac failure

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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

              Initiate therapy in a setting with adequate personnel and equipment for physiologic monitoring and emergency care; dose initiation has been performed during right heart catheterization and without cardiac catheterization; during dose initiation, asymptomatic increases in pulmonary artery pressure coincident with increases in cardiac output reported rarely; in such cases, consider dose reduction, but such an increase does not imply that chronic treatment is contraindicated

              Abrupt withdrawal (including interruptions in drug delivery) or sudden large reductions in dosage may result in symptoms associated with rebound pulmonary hypertension, including dyspnea, dizziness, and asthenia; in clinical trials, death attributable to interruption of therapy reported; avoid abrupt withdrawal

              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

              Some patients may develop pulmonary edema during dosing adjustments

              Chronic use and dose adjustment

              • During chronic use, deliver drug continuously on an ambulatory basis through a permanent indwelling central venous catheter; unless contraindicated
              • Administer anticoagulant therapy to patients receiving therapy to reduce risk of pulmonary thromboembolism or systemic embolism through a patent foramen ovale
              • To reduce risk of infection, use aseptic technique in reconstitution and administration of therapy and in routine catheter care
              • Because drug is metabolized rapidly, even brief interruptions in delivery of drug may result in symptoms associated with rebound pulmonary hypertension including dyspnea, dizziness, and asthenia
              • Intravenous therapy will likely be needed for prolonged periods, possibly years, so consider patient’s capacity to accept and care for a permanent intravenous catheter and infusion pump
              • Adjust dosage during chronic use at first sign of recurrence or worsening of symptoms attributable to pulmonary hypertension or occurrence of adverse events associated with drug; following dosage adjustments, monitor standing and supine blood pressure and heart rate closely for several hours
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              Pregnancy & Lactation

              Pregnancy

              Limited published data from case series and case reports have not established an association with therapy and major birth defects, miscarriage or adverse maternal or fetal outcomes when treatment is used during pregnancy; there are risks to the mother and fetus from untreated pulmonary arterial hypertension; in animal reproduction studies, pregnant rats and rabbits received epoprostenol sodium during organogenesis at exposures of 2.5 and 4.8 times the maximum recommended human dose (MRHD), respectively, and there was no effect on the fetus

              Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death

              Lactation

              There are no data on presence of epoprostenol in either human or animal milk, effects on breastfed infant, or on milk production; the developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

              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
              • Do not use preparation and administration materials containing polyethylene terephthalate (PET) or polyethylene terephthalate glycol (PETG); PET/PETG products may become damaged when used with Flolan’s mfr supplied with sterile diluent which is alkaline (pH 12)

              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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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              epoprostenol (glycine) intravenous
              -
              1.5 mg vial
              epoprostenol (glycine) intravenous
              -
              0.5 mg vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              epoprostenol (glycine) intravenous

              EPOPROSTENOL - INJECTION

              (E-poe-PROST-en-ol)

              COMMON BRAND NAME(S): Flolan

              USES: This medication is used to treat high blood pressure in the lungs (pulmonary arterial hypertension). It helps to increase your ability to exercise and improve symptoms such as shortness of breath and tiredness. It works by relaxing and widening the blood vessels (arteries) in the lungs and other parts of the body so that blood can flow more easily. This medication belongs to a class of drugs known as vasodilators.

              HOW TO USE: When you first start using this medication, it must be given by a health care professional in a hospital or clinic. This medication is given as a continuous injection into the vein using an infusion pump, or as directed by your doctor.Follow all instructions from your health care professional about how to properly use and prepare this medication and the infusion pump. Learn how to properly care for your injection site and how to avoid infection. Also learn how to store and discard needles and medical supplies safely. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid, and contact your health care professional right away. If you have any questions about the use of this medication or the infusion pump, consult your health care professional.Do not suddenly decrease the dose or suddenly stop using this medication because doing either may lead to serious (rarely fatal) worsening of your condition. If you must stop this medication, gradually reduce the dose as directed by your doctor. Consult your doctor right away if your infusion is interrupted or if you develop worsening trouble breathing, dizziness, or weakness. To avoid interruptions in drug treatment, you should have a backup infusion pump and infusion sets available in case your equipment fails. Consult your health care professional for more information.The dosage is based on your medical condition, weight, and response to treatment. Your doctor may also direct you to use additional medications to treat your condition and prevent problems. Use all prescribed medications exactly as directed.Tell your doctor if your condition does not improve or if it worsens.

              SIDE EFFECTS: Nausea, vomiting, diarrhea, dizziness, headache, flushing, sweating, abdominal pain, jaw pain, muscle/joint pain, or pain/redness/swelling at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as anxiety, nervousness, confusion, agitation), signs of infection (such as fever, chills), numb/tingling/pale skin, fast/slow/irregular heartbeat, vision changes, chest pain, unusual bruising/bleeding.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using epoprostenol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart failure (on the left side of the heart), bleeding problems (such as bleeding of the stomach/intestines), blood disorders (such as thrombocytopenia), liver disease.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Discuss the risks and benefits with your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: antiplatelet drugs (such as clopidogrel).Check all prescription and nonprescription medicine labels carefully since many contain pain relievers/fever reducers (aspirin, NSAIDs such as ibuprofen, naproxen) that can increase the risk of bleeding or medicines (such as cough-and-cold products, diet aids) that could increase your blood pressure or heart rate. Ask your pharmacist about using those products safely.However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as blood pressure, heart rate) should be performed from time to time to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: This drug is to be given continuously as an infusion. If your infusion is interrupted, contact your doctor or pharmacist right away.

              STORAGE: Store unopened vials at room temperature away from light and moisture. Consult your pharmacist for details about the storage of opened vials and prepared solutions. Do not freeze. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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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.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • 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.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.