MASSACHUSETTS GENERAL HOSPITAL

Department of Pharmacy

Department of Nursing

Critical Care

Generic Name: Epoprostenol Sodium

Trade Name: Flolan ®

Action: Prostaglandin with anti-proliferative and vasodilatory properties.

Indications: Pulmonary Hypertension

Administration Guidelines:

Must be mixed by pharmacy

Reconstitute with supplied diluent only

Do not give with other parenteral medications or carriers

IV Administration set must have an air-eliminating filter.

Avoid abrupt withdrawal. If therapy is interrupted for any period of time, notify physician

A dedicated central venous catheter is required for administration

A peripheral line may be used until a central line can be placed

Invasive blood pressure monitoring (e.g. a-line) should be considered when centrally administered vasoactive agents are used or when frequent changes in infusion rate are required.

Usual Adult Dosage:

For patients initiating Flolan pharmacy will be contacted to fill out an Induction Sheet. Once on stable dose pharmacy will fill out a Flolan worksheet.

Dosing will be verified by both the pharmacist and nurse

Initial dose: 1-2 ng/kg/min IV; titrate in 1-2 ng/kg/min increments every 15-30 minutes

See Flolan Induction Sheet for complete titration instructions

Maintenance dose: titrated based on response and side effects

Standard Concentrations:

CONCENTRATIONS

150,000 ng/50ml 3,000 ng/ml
250,000 ng/50ml 5,000 ng/ml
500,000 ng/50ml 10,000 ng/ml
1,000,000 ng/50ml 20,000 ng/ml
1,500,000 ng/50ml 30,000 ng/ml

Note: syringes will no longer be used

Special considerations:

Mandatory insurance approval prior to pharmacy dispensing

Do not bolus at any time

Patient must be stabilized on a dose or an adjusted dose at least 48 hours prior to discharge

Bag is only stable for 8 hours at room temperature and 48 hours when refrigerated

Keep all extra supply in refrigerator

Change bag every 8 hours

Tubing must be changed every 72 hours

Do not flush a catheter with Flolan in the line. Withdraw 3 ml of fluid/blood from the catheter into a syringe and discard. After the flush, the catheter will need to be primed via the infusion pump to restart the infusion. The line should be primed with flolan diluent only.

Precautions and Side Effects:

Abrupt withdrawal or large reduction in dosage can be life-threatening and may result in: Rebound pulmonary hypertension, shortness of breath, dizziness, weakness, fatigue, death

Adverse effects: Facial flushing, Tachycardia, Hypotension, Nausea/vomiting

Pregnancy category: B

Breast feeding: Unknown

Contraindications:

Hypersensitivity to epoprostenol products

CHF with severe LV dysfunction

 

 

6/01