epoprostenol sodium: clinical use

Prescribing considerations

• Initiation and ongoing management of pulmonary arterial hypertension require an experienced specialist service.
• Confirm that the patient or carer can maintain aseptic preparation, catheter care, pump operation and emergency backup arrangements.
• Avoid abrupt withdrawal or large unplanned reductions because potentially fatal rebound pulmonary hypertension can occur.
• Consider bleeding risk, especially with anticoagulants, NSAIDs, antiplatelet medicines or thrombocytopenia.
• Use extreme caution in coronary artery disease.
• Safety and efficacy in children have not been established in the selected product information.

Contraindications and cautions

• Hypersensitivity to epoprostenol or any excipient.
• Congestive heart failure caused by severe left-ventricular dysfunction.
• Chronic use in a patient who develops pulmonary oedema during initial assessment.

Monitoring

• Blood pressure and heart rate during administration and after clinically directed changes.
• Symptoms, functional response and signs of excessive vasodilation.
• Catheter site, delivery system and signs of bloodstream infection.
• Bleeding, platelet count and anticoagulant monitoring where relevant.
• New pulmonary oedema during initial assessment.
• Blood glucose when clinically indicated.

Clinical pharmacology

Epoprostenol is a very short-acting prostacyclin and potent pulmonary and systemic vasodilator. It raises intracellular cyclic AMP, reduces platelet cytoplasmic calcium and inhibits aggregation. Rapid degradation at physiological pH explains the need for uninterrupted infusion.

Formulation and product differences

• Veletri contains arginine and sucrose and produces a high-pH diluted solution; other products may use different buffers and have different preparation, storage and administration requirements.
• Reconstitute Veletri only with sterile water for injection or sodium chloride solution as specified, using the same diluent for further dilution.
• The high-pH solution can damage tissue after extravasation.
• Use only compatible reservoirs, tubing, filters and pumps. PET and PETG materials are not recommended because compatibility has not been established.

Solution for infusion

Route: Intravenous

Strengths: 0.5 mg, 1.5 mg