Epoprostenol (prostacyclin)

Epoprostenol = prostacyclin (naturally-occurring PGI₂) in medication form

Administration

• Type: Prostaglandin
• Dosage Forms:
• Routes of Administration: IV, nebulized
• Common Trade Names: Flolan

Adult Dosing

• IV: 2 ng/kg/min initially, titrate upward by 2 ng/kg/min q15m until intolerance or dose-limiting effects occur. Avoid abrupt withdrawal: gradually decrease dose by 2ng/kg/min q15min.
• Nebulized: dosing not well standardized, usually 12.5-50 ng/kg/min

Pediatric Dosing

Safety/efficacy not well established (though some PICUs do use it)

Special Populations

• Pregnancy Rating: B
• Lactation risk: Infant risk cannot be ruled out

Renal Dosing

• Adult:
• Pediatric:

Hepatic Dosing

• Adult:
• Pediatric:

Contraindications

• Allergy to class/drug
• LV failure

Adverse Reactions

Serious

• Hemorrhage
• Hypersplenism
• Infection

Common

• Tachycardia, bradyarrythmia
• Hypotension
• Nausea/vomiting, diarrhea, abdominal pain
• Flushing
• Headache, dizziness
• Musculoskeletal pain

Pharmacology

• Half-life: ~6 min
• Metabolism: Extensively and rapidly metabolized in blood
• Excretion: Mostly renal

Mechanism of Action

• Prostaglandin→ stimulates vasodilation of pulmonary and systemic arteries. Also inhibits platelet aggregation.

See Also

• Pulmonary hypertension

References

Authors

Claire, Daniel Eggeman, Michael Holtz