Why is this medication prescribed?

Flolan, also known as epoprostenol, is prescribed primarily for the treatment of pulmonary arterial hypertension (PAH). PAH is a type of high blood pressure that affects the arteries in the lungs and the right side of the heart. Flolan works by dilating the blood vessels in the lungs, which helps to decrease the blood pressure in the lungs and improve blood flow. This can alleviate symptoms such as shortness of breath and fatigue and can improve exercise capacity and quality of life in patients with PAH.

How should this medicine be used?

Flolan (epoprostenol) is typically administered through continuous intravenous infusion using a special pump and catheter that are surgically placed into a large vein. Here are the general steps for using Flolan:

• Preparation: Flolan is supplied in vials containing a powder form of the medication. Before administration, the powder must be reconstituted with sterile diluent according to the manufacturer’s instructions. Once reconstituted, the solution should be clear and colorless.
• Catheter Placement: A central venous catheter is surgically placed into a large vein, usually in the chest area. This catheter is connected to an infusion pump, which delivers the Flolan solution directly into the bloodstream.
• Pump Setup: The infusion pump is programmed to deliver the prescribed dose of Flolan at a specified infusion rate. The pump is typically set up with safety alarms to alert the patient or caregiver of any issues, such as occlusion or low battery.
• Administration: The Flolan infusion is started at a low dose and infusion rate, as prescribed by the healthcare provider. The dose and infusion rate may be adjusted over time based on the patient’s response and tolerability. Flolan is typically infused continuously, 24 hours a day, 7 days a week.
• Monitoring: Patients receiving Flolan require close monitoring by healthcare professionals. Vital signs, including blood pressure, heart rate, and oxygen saturation, should be monitored regularly. Additionally, patients should be monitored for signs of drug efficacy and potential side effects.
• Maintenance: The infusion pump and catheter require regular maintenance to ensure proper function and prevent complications. This includes flushing the catheter with saline solution and changing the infusion tubing and solution as directed by the healthcare provider.
• Education: Patients and caregivers should receive thorough education on how to use the infusion pump, administer Flolan, recognize signs of complications, and respond appropriately. They should also be provided with contact information for healthcare providers in case of emergencies or concerns.

It’s important to note that Flolan should only be used under the supervision of a healthcare provider experienced in the treatment of pulmonary arterial hypertension (PAH). Patients should follow their doctor’s instructions carefully regarding dosing, administration, and monitoring.

Other uses for this medicine

These off-label uses may include:

• Acute respiratory distress syndrome (ARDS): Flolan may be used in some cases of ARDS to improve oxygenation and pulmonary hemodynamics.
• Persistent pulmonary hypertension of the newborn (PPHN): Flolan may be used in neonates with PPHN to improve pulmonary blood flow and oxygenation.
• Reperfusion injury: Flolan may be used in some cases of reperfusion injury, such as during organ transplantation, to improve blood flow and reduce ischemic damage.

What special precautions should I follow?

Regarding special precautions for Flolan use, here are some important considerations:

• Intravenous administration: Flolan is administered intravenously and requires specialized equipment for delivery. It should only be administered by healthcare professionals who are trained in its use.
• Catheter-related complications: Flolan is delivered through a central venous catheter, which carries risks of complications such as infection, thrombosis (blood clot formation), and catheter malfunction. Patients should be monitored closely for signs of catheter-related complications.
• Dose titration: Flolan requires careful titration to achieve optimal therapeutic effects while minimizing side effects. Patients should be closely monitored during dose adjustment.
• Drug interactions: Flolan may interact with other medications, including anticoagulants and antiplatelet agents, which could increase the risk of bleeding. Patients should inform their healthcare providers about all medications they are taking before starting Flolan.
• Pregnancy and breastfeeding: The safety of Flolan use during pregnancy and breastfeeding has not been established. Women who are pregnant or breastfeeding should discuss the risks and benefits of Flolan with their healthcare provider.
• Side effects: Flolan may cause side effects such as headache, flushing, jaw pain, nausea, diarrhea, low blood pressure, and increased risk of bleeding. Patients should be aware of these potential side effects and report any concerns to their healthcare provider.
• Monitoring: Patients receiving Flolan require regular monitoring of vital signs, blood tests, and echocardiograms to assess treatment response and detect any adverse effects.

Overall, Flolan should be used with caution and under the supervision of a healthcare professional experienced in the management of pulmonary arterial hypertension or other conditions for which it may be prescribed.

What special dietary instructions should I follow?

Regarding special dietary instructions for Flolan, there are no specific dietary restrictions associated with its use. However, it’s important for patients with pulmonary arterial hypertension to follow a heart-healthy diet, which typically includes:

• Eating a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.
• Limiting sodium intake to help manage fluid retention and reduce the workload on the heart.
• Avoiding excessive alcohol consumption, as it can worsen symptoms of pulmonary arterial hypertension.

What should I do if I forget a dose?

• Contact healthcare provider: Patients should contact their healthcare provider as soon as possible to inform them of the missed dose and receive guidance on how to proceed.
• Resume dosing schedule: Patients should resume their regular dosing schedule as soon as possible. However, they should not double the dose to make up for the missed one unless instructed to do so by their healthcare provider.
• Monitoring: Patients should monitor their symptoms closely after missing a dose and report any changes or concerns to their healthcare provider.

What side effects can this medication cause?

Flolan (epoprostenol) can cause various side effects, some of which may require medical attention. Common side effects of Flolan include:

• Flushing (redness and warmth of the skin)
• Headache
• Jaw pain
• Nausea
• Diarrhea
• Hypotension (low blood pressure)
• Dizziness
• Fatigue
• Rash
• Injection site pain or irritation
• Bruising or bleeding at the catheter insertion site
• Fever

Some less common but more serious side effects of Flolan may include:

• Bleeding complications: Flolan can increase the risk of bleeding, particularly in patients taking anticoagulant medications or with other bleeding disorders. Signs of bleeding complications include easy bruising, prolonged bleeding from cuts or wounds, and blood in the urine or stool.
• Infections: Flolan is delivered through a central venous catheter, which increases the risk of catheter-related infections. Symptoms of infection may include fever, chills, redness or swelling at the catheter site, and signs of systemic infection such as fatigue and body aches.
• Pulmonary edema: Flolan can worsen pulmonary edema (fluid accumulation in the lungs) in some patients, particularly those with underlying heart or lung disease. Symptoms may include worsening shortness of breath, cough, and chest pain.
• Hypersensitivity reactions: Some patients may experience allergic reactions to Flolan, which can cause symptoms such as itching, hives, swelling of the face or throat, difficulty breathing, and anaphylaxis (a severe, life-threatening allergic reaction).
• Thrombosis: Flolan may increase the risk of blood clots forming in the veins (venous thrombosis) or arteries (arterial thrombosis), which can lead to serious complications such as stroke or pulmonary embolism. Symptoms of thrombosis may include pain, swelling, warmth, or redness in the affected area.

Patients should be aware of these potential side effects and report any symptoms to their healthcare provider promptly. It’s important to follow up regularly with healthcare providers while taking Flolan to monitor for side effects and adjust treatment as needed.

What should I know about storage and disposal of this medication?

Storage and disposal of Flolan:

• Storage: Flolan should be stored at room temperature (between 68°F to 77°F or 20°C to 25°C) away from light and moisture. Do not freeze Flolan. Keep the medication in its original packaging until ready to use.
• Disposal: Unused or expired Flolan should be disposed of properly according to local regulations or guidelines. Do not dispose of Flolan by flushing it down the toilet or pouring it down the drain unless instructed to do so by a healthcare professional or pharmacist. Instead, consult with a healthcare provider or pharmacist on the appropriate disposal method, which may involve a drug take-back program or special disposal instructions.

In case of emergency/overdose

In case of emergency or overdose of Flolan:

• Seek medical attention immediately: If you suspect an overdose or experience severe symptoms after using Flolan, such as severe hypotension (low blood pressure), severe headache, difficulty breathing, or loss of consciousness, seek emergency medical attention or call your local poison control center at once.
• Inform healthcare provider: If possible, inform your healthcare provider about the overdose or emergency situation. Provide information about the amount of Flolan taken, the timing of ingestion, and any symptoms experienced.

What other information should I know?

• Regular monitoring: Patients receiving Flolan require regular monitoring by healthcare professionals to assess treatment response, adjust dosing, and monitor for side effects or complications. This may include monitoring of vital signs, blood tests, echocardiograms, and catheter function.
• Lifestyle modifications: Patients with pulmonary arterial hypertension (PAH) may benefit from certain lifestyle modifications to manage their condition, such as quitting smoking, maintaining a healthy weight, staying physically active within recommended limits, and following a heart-healthy diet low in sodium and saturated fats.
• Travel considerations: Patients using Flolan may need to plan ahead when traveling, as the medication requires continuous intravenous infusion. This may involve arranging for portable infusion pumps, supplies, and medications, as well as coordinating with healthcare providers at the travel destination.
• Medication interactions: Flolan may interact with other medications, including anticoagulants, antiplatelet agents, and certain other drugs. Inform your healthcare provider about all medications, supplements, and herbal products you are taking before starting Flolan to avoid potential interactions.
• Pregnancy and breastfeeding: The safety of Flolan use during pregnancy and breastfeeding has not been established. Women who are pregnant or breastfeeding should discuss the risks and benefits of Flolan with their healthcare provider before starting treatment.
• Follow-up appointments: Patients should follow up regularly with their healthcare provider while taking Flolan to monitor their condition, adjust treatment as needed, and address any concerns or questions.

It’s important to follow healthcare provider’s instructions and guidance while using Flolan to ensure safe and effective treatment.