Epoprostenol is a vasodilator drug that helps to improve the health and physical stamina of patients with pulmonary hypertension. Pulmonary hypertension is the high blood pressure that forms in the major artery connecting the heart to the lungs. Smaller blood vessels in the lungs may become resistant to blood flow due to various reasons, which increase the workload of the heart as it then needs to pump harder to transport blood to the lungs. Epoprostenol helps to relax and dilate these blood vessels, which in turn allows for less work from the heart.
Patients starting with epoprostenol will usually receive treatment in a hospital or clinic, with the medicine administered by a healthcare professional. However they can request to receive the medicine at home, in which case the person giving the medicine (whether it is the patient themself or a caregiver) must be fully familiar with the procedure of preparing and infusing the medication.
Epoprostenol primarily comes in the form of a powder, which is to be reconstituted with a sterile diluent provided together with the medicine. Hygiene is of utmost importance while using this medicine.
Used correctly, epoprostenol that works as intended helps patients to maintain a good quality of life, by allowing them to exercise as normal and giving them the stamina they require to perform various daily activities.
When using epoprostenol, there is a chance that patients may encounter side effects, although not everyone who uses the medicine will do so. These side effects range from mild to severe. The following lists more common side effects that should go away after a while. However, if they persist or worsen, the patient should let their doctor know. They should also ask their doctor any questions that they have about any possible side effects
More serious side effects may occur, although they are quite unlikely. If the patient experiences the following, they should seek immediate medical attention:
Rare side effects on this medicine include:
The above is not a complete list of side effects that a patient may encounter. If the patient notices any unusual sign or symptom, they should contact their doctor as soon as possible for further advice.
It is unlikely that a patient will have an allergic reaction to the medicine. However in the event that it happens, the patient should get emergency treatment. Patients should keep an eye out for:
Epoprostenol is infused into the patient via a catheter, which is placed into a vein in the chest which leads to the heart. Initial treatment with this medicine should take place at a hospital or clinic, with the medication administered to the patient. If the patient chooses to take the medicine at home, a qualified healthcare professional such as the doctor or nurse will show the patient or their caregiver how to use this medication. They will teach the patient or their caregiver how to prepare the medicine, and how to use the pump that is required for the infusion. This portable pump is operated by a computer, and will feed epoprostenol steadily and continously to the patient's heart, via the catheter.
During treatment, the doctor should perform regular checks on the patient to ensure that the medication is working as intended. If the patient notices any change or worsening of their condition, they should inform their doctor as quickly as possible.
As epoprostenol comes in a powder, it is mixed with a diluent to then be infused. It should be mixed only with the sterile diluent that is provided with the medication, and not with anything else. After reconstitution, the epoprostenol solution should not be mixed with other medicines or solutions.
The patient should follow the doctor's prescription exactly, and not use more, or less than the medicine they have been instructed to take.
The following describes the procedures used in handling epoprostenol for daily use. It should not be used as a replacement for a demonstration by a qualified healthcare professional such as a doctor or nurse. If the patient or caregiver has any questions regarding the procedures or medicine, they should clarify everything with their doctor or nurse prior to using epoprostenol.
For reconstituting epoprostenol daily:
Withdrawing the sterile diluent:
Reconstituing the epoprostenol:
Withdrawing epoprostenol that has been reconstituted:
Injecting the epoprostenol solution into the cassette:
Injecting remaining diluent into the partially filled cassette:
Injecting the sterile diluent into the cassette:
Removing air from the cassette:
Using the portable pump:
If the entire vial has been mixed with the 5ml solution provided, the solution can be infused by the pump for up to 24 hours at room temperature. If a lower concentration is being used, it can only be infused for up to 12 hours. The solution should not be placed in direct sunlight.
In the case of any problems arising with the portable pump, the patient or their caretaker should contact their doctor. They may be given a second pump in the event that the original pump stops working. The patient should ensure that the back-up pump is within reach at all times.
Before using any of the vials, the patient or their caretaker should inspect the fluid in the vials. If they notice any solid pieces, specks, changes of color or any other signs of contamination or change, they should discard the vial and use another.
It is important to use only the supplies provided by the doctor or that are in the packaging, as supplies from other sources may not have the wanted effect. For instance, the provided infusion tubing has a filter to remove specks and particles in the liquid.
Epoprostenol may be required for several years by the patient. If the patient has any questions or concerns about the length of treatment, they should discuss it with their doctor prior to beginning treatment with epoprostenol.
The patient's dosage will depend on the concentration of their reconstituted medication, as well as the rate of the medicine's delivery by the infusion pump. They should take only the required amount of medication- no more, no less, and as their dosing schedule requires. The following lists an average dose, which may differ from the patient's:
For primary pulmonary hypertension, and pulmonary hypertension secondary to the scledroderma spectrum of disease:
If the patient has missed a dose, they should contact their doctor right away to seek further medical advice.
Patients should not abruptly stop or decrease their intake of the medicine without prior approval from their doctor as it may lead to adverse and possibly serious reactions. On rare occasions these reactions may be fatal. If they wish to stop the medication, patients should consult their doctor and decrease their dosage gradually.
If dosage is interrupted at any point, patients should ask their doctor for further advice.
Drugs may interact with each other, with various supplements or herbal products. These interactions may lead to an increased chance of side effects, or affect the efficiency of the medication. Patients should keep a list of any drugs, supplements or herbal products they are currently consuming so that they can share the list with their doctor or pharmacist. Sometimes, the doctor may prescribe a medicine that has been known to interact with epoprostenol if they deem it necessary. In these cases, patients should discuss with their doctor ways to reduce chances of side effects.
Patients should not start, stop or change the amount of any medicine or supplements they are currently taking without the consent or knowledge of their doctor.
Epoprostenol may increase the chance of unusual bleeding, and certain medicines may make it worse. Patients are highly advised to consult with their doctors if they are using or are planning to use:
In certain cases, the doctor may prescribe a low dosage of aspirin for the patient in order to help prevent strokes or heart attacks. Digoxin may also be prescribed in conjunction with epoprostenol. If the patient has any questions about the interactions between aspirin or digoxin with epoprostenol, they should speak with their doctor for further advice.
The following is an incomplete list of medications that may interact with epoprostenol:
Alcohol and tobacco are common products that may interact negatively with epoprostenol. Patients should check with their doctor on whether they should use either alcohol or tobacco during treatment with this medicine.
Certain diseases may also affect the use of epoprostenol. Patients with the following conditions should let their doctor know prior to starting treatment:
Prior to starting epoprostenol, patients should tell their doctor if they have any allergies, whether it is to the medication itself, any other drugs, or food, dyes or ingredients. This is to prevent an allergic reaction, either to the drug, any inactive ingredients it contains, or materials from the accessories required for the infusion of the drug.
Patients should also tell their doctor about their medical history, especially if they have had the following conditions:
Epoprostenol may cause dizziness. Patients on this medicine should not perform any activities that require mental alertness until they are certain they can do them safely, such as driving or operating machinery. It is also advisable for patients to limit or even refrain from alcoholic drinks. Patients can help lower the chances of dizziness by rising slowly, if they have been in a sitting or lying down position.
For pregnant patients, this medication should only be used if necessary. Patients who are planning to become pregnant should inform their doctors prior to starting epoprostenol. Currently there is insufficient information on whether epoprostenol passes into breast milk. Breastfeeding patients should check with their doctors for further medical advice.
Epoprostenol is not expected to work differently with elderly patients. However they may be at increased risk for age-related heart, kidney and liver problems, which may require an adjustment in their dosage, which will be determined by their doctor.
If the patient is scheduled to go into surgery, they should let their doctor or healthcare givers know if they are on any medication.
The medicine vial should be stored in its original carton in a cool and dry place, at about room temperature. It should not be exposed to freezing temperatures at any point. Epoprostenol should also not be stored in the bathroom as it may be too humid.
Any mixed solution of epoprostenol may be kept in the refrigerator for up to 5 days, away from direct light. It may also be stored at room temperature, up to 77 degrees Fahrenheit, for up to 48 hours. After 5 days in the refrigerator or 2 days in room temperature, the solution should be thrown away. Medicine that has been frozen should also be discarded.
The medicine should be kept out of the reach of children or animals.
Once the medication is expired or no longer needed, the patient should dispose of it through the proper channels. If they are unsure on how to deal properly with medical waste, the patient should ask their doctor or local waste management.
Needles and syringes should not be reused. Once they have been used, they should be put in a puncture-resistant container to be disposed of. They are also considered to be part of medical waste.
Epoprostenol is a medicine used to treat pulmonary arterial hypertension, or high blood pressure in the main artery that connects the ventricle, or right side of the heart, to the lungs. Due to several factors, smaller blood vessels in the lungs may become more resistant to blood flow, which forces the ventricle to work harder in order to pump blood to the lungs. Epoprostenol works to decrease the workload on the heart, by relaxing these blood vessels and by increasing blood flow to the lungs.
By helping blood flow more easily from the heart to the lungs, epoprostenol helps patients to have an active and healthy life by allowing them to exercise and perform various daily activities. It also helps patients if they have trouble with breathing, and fatigue, thereby improving their quality of life.
This medicine primarily comes in the form of a powder, and is mixed with a sterile diluent that comes with it, before it is slowly and steadily infused into the patient via a portable infusion pump. Epoprostenol should not be mixed with any other solutions or medicine.
Before starting treatment, a doctor or nurse will show the patient or their caregiver how to properly prepare the medicine for use, and how to infuse it into the patient. Patients should clarify the procedure thoroughly before attempting it on their own. It is advised that patients make two cassettes to begin with, and then thereafter use the cassette of medicine that they prepared the previous day, so that they will have a back-up if it is required. It is also advised that they have a back-up infusion pump, as it may be detrimental to the patient's health if they miss a dose.
Hygiene during the procedure of infusion and preparation of the medicine is highly important when taking this medicine.
Certain other medications and conditions may affect the effectiveness of epoprostenol, or even increase the chances of the patient developing unwanted side effects. Medications of note include drugs that may increase chances of bleeding, such as antiplatelet drugs or NSAIDs. Patients who have congestive heart failure or pulmonary edema may be asked to refrain from using epoprostenol altogether as the negative effects of the medication on their health may outweigh any benefits it brings.
Pregnant or breastfeeding patients may want to discuss how epoprostenol may affect them as there are currently insufficient information and studies on how the drug affects babies and breastfeeding infants. For elderly patients, there is an elevated risk of age-related problems with the kidney, liver and heart.
Epoprostenol belongs to a class of drugs known as vasodilators and work by relaxing blood vessels in the lungs so as to prevent work overload on the heart.
-Remove the syringe and replace the end cap of the cassette tubing. Label the cassette with the time and date of the cassette preparation.