Critical Care Trauma Centre

EPOPROSTENOL (PGI2, PGx, FlolanR)

Name: EPOPROSTENOL (PGI2, PGx, FlolanR)
Classification:

NOTE:
This monograph is for Flolan (epoprosentol - GM).  The current LHSC formulary brand is epoprostenol - AS (Caripul)

prostaglandin, metabolite of arachidonic acid

  • direct vasodilation of pulmonary and systemic arterial vascular beds
    • reduction of right and left heart afterload 
    • useful in the management of pulmonary hypertension
  • inhibition of platelet aggregation 
Dose:
  • acute dose-ranging for primary pulmonary hypertension:
    • 2 ng/kg/min, increased in increments of 2 ng/kg/min every 15 minutes or longer until dose-limiting pharmacological effects
  • chronic continuous infusion for primary pulmonary hypertension:
    • initiate at 4 ng/kg/min less than the maximum-tolerated infusion rate during acute dose-ranging; if maximum rate was less than 5 ng/kg/min then start at one-half the maximum-tolerated rate
    • increase infusion by 1-2 ng/kg/min increments as required (minimum 15 minute intervals)
Administration: IV Infusion: 
For primary pulmonary hypertension:  3000 ng/ml, 5000 ng/ml, 10 000 ng/ml or 15 000 ng/ml in 50 or 100 ml bags or cassettes 
  • epoprostenol must be reconstituted only with specific sterile diluent; may not be mixed or administered with any other parenteral medication or solution prior to or during administration
  • infusions must remain protected from light and must be kept between 2-8° Celsius at all times
    • hang one ice pack with the IV bag in a stockingette 
    • change ice pack q 6 h (do not allow infusion to freeze)
  • IV bag and tubing must be wrapped in aluminum foil to protect from light
    • use continuo-flo tubing without extension
  • change infusion q24h
Adverse Effects:
  • during acute dose-ranging for primary pulmonary  hypertension:
    • flushing, hypotension
    • headache
    • nausea/vomiting
    • nervousness, agitation
    • chest pain
  • during chronic administration:
    • flu-like symptoms
    • tachycardia, flushing
    • nausea, vomiting, diarrhea
    • musculoskeletal pains
    • neurological:  anxiety, nervousness, dizziness, headache, hyperesthesia, paresthesia
  • local irritation at injection site
Monitoring Therapy:
  • IV site
  • continuous heart rate and rhythm
  • blood pressure
  • central or mixed venous oxygen saturation
  • lactate
  • blood gases
  • pulmonary artery pressures if in use
  • cardiac output if being monitoring
Caution:
  • contraindicated in patients with congestive heart failure due to severe left ventricular systolic dysfunction
  • infusions for primary pulmonary hypertension should not be interrupted for any period of time due to an extremely short half life of epoprostenol and consequent adverse effects of withdrawal of drug therapy
Drug Interactions:
  • epoprostenol + non-steroidal anti-inflammatories = potential increased risk of bleeding
Adult Critical Care Protocol:

  • May be administered by IV infusion and titrated by a nurse in Adult Critical Care

  • Continuous infusions must be administered by infusion device and the pump library must be enabled.

  • Placement of an arterial line for blood pressure monitoring is preferred

  • Administer via central venous access device.

 

Last Revised: September 20, 2018, January 23, 2019