Epoprostenol

How it works

It is a potent vasodilator of pulmonary and systemic arterial beds and inhibits platelet aggregation by stimulating prostacyclin receptors and increasing intracellular cyclic AMP.

Prescribing in practice

• Abrupt interruption of the continuous infusion can precipitate life-threatening rebound pulmonary hypertension, so a backup delivery system and uninterrupted dosing are essential.
• It has a very short half-life and is unstable, requiring reconstitution with the specific buffer and delivery through a dedicated indwelling central line.
• Systemic effects include hypotension, flushing, jaw pain and headache, and it potentiates the effect of other antihypertensives and anticoagulants.

Monitoring

Monitor blood pressure, heart rate and signs of infusion-related effects continuously during initiation and dose titration, with central line care to detect catheter-related sepsis.

Counselling the patient

• Never stop or pause the pump without medical advice as symptoms can return suddenly and severely.
• Report fever, line-site redness, dizziness or fainting promptly.
• Carry spare pump consumables and know how to manage an infusion failure.

Evidence & guidelines

Long-established as a first-line parenteral therapy for advanced pulmonary arterial hypertension and supported by UK pulmonary hypertension specialist guidance.