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Prostaglandin I2 (PGI2)(trade name),
Prostaglandin X (PGX)(trade name),
Pregnancy Category: B
Pulmonary arterial hypertension (WHO Group 1).
A prostaglandin that directly dilates pulmonary and systemic arterial vasculature.
Also inhibits platelet aggregation.
Improved exercise capacity.
Absorption: IV administration results in complete bioavailability.
Metabolism and Excretion: Rapidly and extensively degraded in plasma; some metabolites are pharmacologically active.
Half-life: ≤6 min.
Time/action profile (hemodynamic effects)
|IV||rapid (within min)||unknown||2–3 min†|
Contraindicated in: Hypersensitivity to epoprostenol or similar compounds; HF due to severe left ventricular systolic dysfunction; Patients who develop pulmonary edema during dose initiation.
Use Cautiously in: Geriatric: Dose adjustments may be necessary; Obstetric / Lactation / Pediatric: Safety not established.
Adverse Reactions/Side Effects
Central nervous system
- anxiety (most frequent)
- headache (most frequent)
- dizziness (most frequent)
- pulmonary edema
- tachycardia (most frequent)
- chest pain (most frequent)
- hypotension (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- abdominal pain (most frequent)
- diarrhea (most frequent)
- flushing (most frequent)
- myalgia (most frequent)
- jaw pain (most frequent)
- hypesthesia/hyperesthesia/paresthesia (most frequent)
- flu-like symptoms (most frequent)
- injection site reactions
Drug-Drug interactionAdditive hypotension may occur with antihypertensives, diuretics, or other vasodilators.Although concurrent use is common and accepted, risk of bleeding may be ↑ by anticoagulants or other agents affecting platelet function.May ↑ levels of digoxin.
Intravenous (Adults) Initiate at 2 ng/kg/min; may ↑ by 2 ng/kg/min every 15 min or longer until dose-limiting adverse effects (e.g. nausea, vomiting, headache, abdominal pain, flushing, or dyspnea) or a tolerance to the effects of the drug are noted. If dose-limiting adverse effects occur, infusion rate may be ↓ in decrements of 2 ng/kg/min at intervals of at least 15 min. Changes in infusion rate should be based upon persistance, recurrence, or worsening of symptoms and/or emergence of adverse reactions. Abrupt withdrawal or large reductions in infusion rate should be avoided.
Availability (generic available)
Powder for injection: 0.5 mg/vial, 1.5 mg/vial
- Monitor hemodynamic parameters (cardiac index, mean pulmonary arterial pressure, pulmonary vascular resistance, total pulmonary resistance, mean systemic arterial pressure) frequently during acute dose ranging and periodically during chronic infusion.
- Acute Dose Ranging: Monitor for dose-limiting side effects (nausea, vomiting, headache, hypotension, flushing, chest pain, anxiety, dizziness, bradycardia, dyspnea, abdominal pain, musculoskeletal pain, tachycardia) frequently.
- Chronic Infusion: Monitor BP (supine and standing) and heart rate closely for several hours after dose adjustments.
- Make dose adjustments during chronic therapy at the first sign of recurrence or worsening of symptoms of pulmonary hypertension or adverse effects of epoprostenol. Most common adverse effects occurring during chronic therapy include headache, jaw pain, flushing, diarrhea, nausea, vomiting, flu-like symptoms, and anxiety.
- Lab Test Considerations: May cause thrombocytopenia.
Potential Nursing DiagnosesDecreased cardiac output (Indications)
Ineffective tissue perfusion (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- Anticoagulant therapy is usually administered concurrently, unless contraindicated, to decrease the risk of pulmonary or systemic embolism.
- Administer via peripheral infusion during acute dose ranging and by chronic continuous infusion via Broviac or Hickman central venous catheter using a programmable ambulatory infusion pump for chronic administration.
- Continuous Infusion: Diluent: For either the 3000- or 5000-ng/mL concentration, dissolve contents of one 0.5-mg vial with 5 mL of sterile diluent for epoprostenol. Withdraw 3 mL for the 3000-ng/mL concentration and the entire vial contents for the 5000-ng/mL concentration and add to a sufficient quantity of sterile diluent for epoprostenol to make a total of 100 mL. Concentration: 3000 ng/mL or 5000 ng/mL. Diluent: For the 10,000-ng/mL concentration, dissolve the contents of two 0.5-mg vials with 5 mL each of sterile diluent for epoprostenol. Withdraw the entire vial contents, and add to a sufficient quantity of sterile diluent for epoprostenol to make a total of 100 mL. Concentration: 10,000 ng/mL. Diluent: For the 15,000-ng/mL concentration, dissolve the contents of the 1.5-mg vial with 5 mL of sterile diluent for epoprostenol or with 5 mL of 0.9% NaCl or Sterile Water for Injection if using Veletri. Withdraw the entire contents of the vial, and add to a sufficient quantity of sterile diluent for epoprostenol to make a total of 100 mL; use same diluent as for reconstitution with Veletri. Use only sterile diluent provided by manufacturer for dilution (except with Veletri). Do not reconstitute or mix with any other parenteral medications or solutions. Concentration: 15,000 ng/mL.
- May require more than one solution strength during acute dose ranging. Usually 3000 and 10,000 ng/mL are used to deliver an infusion rate between 2–16 ng/kg/min.
- Unopened vials and reconstituted solutions must be protected from light. Reconstituted solutions are Stable for 8 hr at room temperature or 48 hr if refrigerated. Do not freeze. Discard any reconstituted solution that has been frozen, has been refrigerated more than 48 hr, or has been at room temperature for more than 8 hr.
- Solutions have been administered while in cold pouches. May be administered while in cold pouches with frozen gel packs over 24 hr, with gel packs changed every 12 hr.
- Rate: Infusion rate usually ranges from 2–16 ng/kg/min in adults.
- Home Care Issues: Instruct patient on reconstitution, administration, and care of the permanent central venous catheter.
- Advise patient of the importance of continuous therapy. Inform patient that even brief interruptions of the infusion may cause symptoms of rebound pulmonary hypertension (dyspnea, dizziness, asthenia). Provide patient with access to a backup infusion pump and intravenous infusion sets to prevent potential interruptions in drug delivery. Also inform patients that therapy may be prolonged, possibly lasting years.
- Increase in cardiac index and stroke volume and decrease in pulmonary vascular resistance, total pulmonary resistance, and mean systemic arterial pressure in patients with PPH.