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Overview: Epoprostenol is used to treat high blood pressure in the lungs. It works by widening blood vessels in the lungs, which makes it easier for blood to flow. Common side effects include dizziness, jaw pain, headache, and flushing. While less common, more serious side effects include low blood pressure and bleeding. Epoprostenol is given continuously through a tube placed in a vein and connected to a small pump.

Uses

What is epoprostenol used for?

Epoprostenol is commonly used for pulmonary arterial hypertension (PAH), a condition where you have high blood pressure in the blood vessels that carry blood from your heart to your lungs.

Epoprostenol may also be used for other conditions as determined by your health care provider.

How does epoprostenol work (mechanism of action)?

Epoprostenol works by widening the blood vessels in the lungs and the rest of the body, making it easier for blood to flow. This reduces strain on the heart.

How is epoprostenol supplied (dosage forms)?

Brands and other names

  • Flolan
  • Veletri

Dosage forms and strengths

Epoprostenol is available in an injectable form that is usually given by a health care provider.

How should I store epoprostenol?

Epoprostenol is usually given by a health care provider in a hospital. If you will store epoprostenol at home, follow the instructions given by your health care provider.

Side Effects

What are the most common side effects of epoprostenol?

The most common side effects of epoprostenol are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Dizziness
  • Jaw pain or stiffness
  • Headache
  • Muscle or joint pain
  • Nausea and vomiting
  • Flushing
  • Fast or slow heartbeat
  • Shortness of breath
  • Pain in your stomach or chest
  • Low blood pressure (see below)
  • Diarrhea
  • Flu-like symptoms
  • Feeling anxious or nervous

There may be other side effects of epoprostenol that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of epoprostenol?

While less common, the most serious side effects of epoprostenol are described below, along with what to do if they happen.

Severe Allergic Reactions. Epoprostenol may cause allergic reactions, which can be serious. Get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Fluid Buildup in the Lungs. Epoprostenol may cause fluid buildup in the lungs (pulmonary edema) in certain people. If you develop this side effect, your health care provider may stop epoprostenol and you may not be able to use it again. Tell your health care provider right away if you have the following symptoms.

  • Any breathing problems that feel more severe or different than usual
  • Coughing, especially when lying down
  • Swelling in the legs, ankles, or abdomen
  • Unusual tiredness
  • Feeling anxious or restless
  • Fast heartbeat

Bleeding. Epoprostenol can prevent blood cells from clumping together (clotting), which can raise your risk of bleeding. This risk may be higher if you take any blood thinner medicines or have conditions that affect your blood’s ability to clot. Tell your health care provider right away if you have any of the following signs of bleeding.

  • Bruising easily
  • Bleeding that takes a long time to stop
  • Coughing up or vomiting blood
  • Black or tarry poop
  • Pink, red, or brown pee

Low Blood Pressure (Hypotension). Epoprostenol may cause low blood pressure. Keep all appointments with your health care provider to check your blood pressure. If you feel faint or dizzy, lie down. Tell your health care provider right away if you have any of the following symptoms.

  • Dizziness, feeling lightheaded, or fainting
  • Confusion
  • Feeling weak or tired

Warnings & Precautions

Who should not use epoprostenol?

Allergies to Ingredients. People who are allergic to any of the following should not use epoprostenol.

  • Epoprostenol
  • Flolan
  • Veletri
  • Any other medicine known as a prostacyclin analog
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific epoprostenol products they stock.

Certain Types of Heart Failure. You should not use epoprostenol if you have left-sided heart failure (also called heart failure with reduced left ventricular ejection fraction, or HFrEF), as it may increase the risk of death. With HFrEF, your heart is too weak to pump enough blood to the rest of your body.

What should I know about epoprostenol before using it?

Epoprostenol is usually given by a health care provider. It may be used at home in some cases, such as for long-term treatment. Do not use epoprostenol unless it has been prescribed to you by a health care provider. Use it as prescribed.

If you use epoprostenol at home, do not share it with other people, even if they have the same condition as you. It may harm them. Keep epoprostenol out of the reach of children. 

There are multiple forms of epoprostenol available. If you use it at home, read and follow the instructions for the product you have and make sure you understand how to prepare and use it properly. It is recommended to keep backup supplies on hand, in case it does not work the way it should.

Epoprostenol is a continuous infusion, which means it is given around the clock through a tube (catheter) placed in a vein and connected to a small pump. This treatment requires close attention, as you or a caregiver will need to prepare the medicine, manage the catheter, and follow strict instructions to be sure it is used safely. 

Epoprostenol treatment may be needed for a long time, possibly years. If the medicine is paused, even for a short time, symptoms of your condition could get worse very quickly. Before starting epoprostenol, talk to your health care provider if you have concerns about managing this treatment. 

Do not stop using epoprostenol or change your infusion rate without talking to your health care provider. Stopping or reducing it too quickly may cause serious side effects. Call your health care provider right away if you have worsening shortness of breath, dizziness, or weakness.

What should I tell my health care provider before using epoprostenol?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if epoprostenol is right for you.

In particular, make sure that you discuss any of the following.

Other Medicines and Supplements. Epoprostenol may interact with other medicines and supplements. Before using epoprostenol, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how epoprostenol could affect pregnancy or harm an unborn baby. Tell your health care provider if you are or plan to become pregnant. Your health care provider will advise you if you should use epoprostenol while you are pregnant or trying to get pregnant.

Breastfeeding. It is not known if epoprostenol passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will advise you if you should stop breastfeeding or stop epoprostenol.

Interactions

Does epoprostenol interact with foods or drinks?

There are no known interactions between epoprostenol and foods or drinks.

It is unknown if drinking alcohol will affect epoprostenol. The risk of dizziness may be increased if you drink alcohol while using epoprostenol.

Does epoprostenol interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

 In particular, make sure that you discuss if you are using any of the following before using epoprostenol.

  • A medicine for high blood pressure or a heart condition
  • A nitrate, such as nitroglycerin (Nitro-Dur, NitroMist, Nitrostat, and others), isosorbide dinitrate (Isordil), or isosorbide mononitrate, which is a medicine used for chest pain caused by a type of heart disease
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • A blood thinner, such as warfarin, which is a medicine used to treat or prevent blood clots
  • An antiplatelet medicine, such as aspirin/dipyridamole, cilostazol, clopidogrel (Plavix), or ticagrelor (Brilinta), which is a medicine used to prevent blood clots
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure

This may not be a complete list of medicines that can interact with epoprostenol. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much epoprostenol?

If you or someone else has used too much epoprostenol, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of epoprostenol?

If there is any pause during your epoprostenol infusion, tell your health care provider right away. Since epoprostenol must be given around the clock (continuously), even a brief interruption can worsen the symptoms of your condition. Your health care provider will guide you on the best steps to take. If you receive epoprostenol in a hospital or health care facility, your health care provider will make sure you are receiving it as scheduled.