EPOPROSTENOL

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A Drug Study Presented To

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In Partial Fulfillment of Requirements in NCM 218-RLE

By:

MICHAEL DAME L. CANTON St. N

August 24, 2021

Brand Name: Flolan, Veletri

Drug Classification: Vasodilators

Mode of Action: 

A prostaglandin that is a powerful vasodilator and inhibits platelet aggregation. It

is biosynthesized enzymatically from prostaglandin endoperoxides in human vascular

tissue. The sodium salt has been also used to treat primary pulmonary hypertension.

Suggested Dose:

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

Indication: 

Therapeutic:

• The treatment of pulmonary arterial hypertension (PAH) (idiopathic or heritable PAH

and PAH associated with connective tissue diseases) in patients with WHO Functional

Class III-IV symptoms to improve exercise capacity and;

• For use in haemodialysis in emergency situations when use of heparin carries a high

risk of causing or exacerbating bleeding or when heparin is otherwise contraindicated. 

Contraindications:
  FLOLAN is contraindicated in patients with heart failure caused by reduced left

ventricular ejection fraction.

 FLOLAN is contraindicated in patients with a hypersensitivity to the drug or any

of its ingredients.

Side Effects:

 Nausea

 Vomiting 

 Diarrhea

  Headache 

 Hypotension

 Flushing

  Dizziness

  Musculoskeletal pain

Adverse Effects:

>10%

 Flushing (58%)

 Jaw pain (54%)

 Myalgia (44%)

 Diarrhea (37%)

 Nausea (32%)
  Vomiting (32%)

 Flu-like symptoms (25%)

 Eczema (25%)

 Rash (25%)

 Urticaria (25%)

 Hypotension (16%)

1-10%

 Musculoskeletal pain (2%)

 Hyperesthesia (1%)

 Tachycardia (1%)

Interaction:

Drug:

Abacavir Abacavir may decrease the excretion rate of Epoprostenol which

could result in a higher serum level.

Abciximab The risk or severity of bleeding can be increased when Abciximab

is combined with Epoprostenol.

Acebutolol Epoprostenol may increase the hypotensive activities of

Acebutolol.

Aceclofenac The risk or severity of bleeding and hemorrhage can be increased

when Aceclofenac is combined with Epoprostenol.

Acemetacin The risk or severity of bleeding and hemorrhage can be increased

Acenocoumarol The risk or severity of bleeding can be increased when

Epoprostenol is combined with Acenocoumarol.

Acetaminophen Acetaminophen may decrease the excretion rate of Epoprostenol

which could result in a higher serum level.

Acetazolamide Acetazolamide may increase the excretion rate of Epoprostenol

which could result in a lower serum level and potentially a

reduction in efficacy.

Acetylsalicylic Acetylsalicylic acid may increase the antiplatelet activities of

acid Epoprostenol.

Aclidinium Epoprostenol may decrease the excretion rate of Aclidinium which

could result in a higher serum level.

Food: 

Avoid herbs and supplements with anticoagulant/antiplatelet activity. Examples include

garlic, ginger, bilberry, danshen, piracetam, and ginkgo biloba.

Nursing Responsibilities:

1. Assess heart rate, ECG, and heart sounds, especially during exercise. Report
any rhythm disturbances or symptoms of increased arrhythmias, including
palpitations, chest pain, shortness of breath, dyspnea, fainting, and
fatigue/weakness.
2. Assess blood pressure (BP) periodically and compare to normal values. Report
low BP (hypotension), especially if the patient experiences dizziness, fatigue, or
other symptoms.
3. Assess dizziness and drowsiness that might affect gait, balance, and other
functional activities. Report balance problems and functional limitations to the
physician and nursing staff, and caution the patient and family/caregivers to
guard against falls and trauma.
4. Assess any muscle or jaw pain to rule out musculoskeletal pathology; that is, try
to determine if pain is drug induced rather than caused by anatomic or
biomechanical problems.
 5. Assess signs of parasthesia (numbness, tingling) or increased/abnormal
sensation. Perform objective tests, including electroneuromyography and
sensory testing to document any drug-related neuropathic changes.
6. Assess IV site during and after IV administration, and report any pain, swelling,
inflammation, or other injection-site reactions.
7. Because of the risk of arrhythmias and abnormal BP responses, use caution
during aerobic exercise and other forms of therapeutic exercise. Assess exercise
tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise
immediately if any untoward responses occur.
8. Avoid physical therapy interventions that cause systemic vasodilation (large
whirlpool, Hubbard tank). Additive effects of this drug and the intervention may
cause a dangerous fall in BP.
9. To minimize orthostatic hypotension, patient should move slowly when assuming
a more upright position.
10. Instruct patient or family/caregivers to report other troublesome side effects such
as severe or prolonged headache, anxiety, skin flushing, flu-like symptoms, or GI
problems (nausea, vomiting, diarrhea, abdominal pain).

References: 

“Flolan (Epoprostenol Sodium): USES, Dosage, Side Effects, Interactions, Warning.”

RxList, RxList, (2 Nov. 2020) Retrieved on August 23, 2021 from www.rxlist.com/flolan-

drug.htm. 

Flolan (Epoprostenol) Dosing, Indications, Interactions, Adverse Effects, and More. (10

Nov. 2020) Retrieved on August 23, 2021 from medscape.com/drug/flolan-

epoprostenol-342398. 

Jones & Bartlett Learning. (2018). 2019 Nurse’s Drug Handbook (18th ed.). Jones &

Bartlett Learning.