A continuous-infusion prostacyclin for high blood pressure in the lung arteries
Epoprostenol
The original prostacyclin, given as a continuous infusion through a permanent line for pulmonary arterial hypertension; it must never be stopped abruptly.
What is Epoprostenol?
Epoprostenol is the original prostacyclin medicine used to treat pulmonary arterial hypertension, which is high blood pressure in the arteries of the lungs. It powerfully relaxes and widens the lung arteries to ease breathlessness and help the heart. Because it works for only a few minutes, it has to be given as a continuous infusion through a permanent line into a large vein, using a portable pump. Stopping it suddenly is dangerous and can cause a rebound worsening, and the line carries a risk of infection. It is started and run by a specialist pulmonary hypertension centre.
Education and reference only. This is a plain-language guide to Epoprostenol — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Epoprostenol is a man-made version of prostacyclin, a natural substance that relaxes blood vessels. It was the first prostacyclin used for pulmonary arterial hypertension — a serious condition where the pressure in the lung arteries is too high — and is often used in more severe disease. Because it breaks down within minutes in the body, it cannot be taken as a tablet or occasional dose; instead it is given as a non-stop infusion through a permanent line (a central line) into a large vein, driven by a small portable pump. It is a highly specialist treatment.
How it works
Prostacyclin normally keeps blood vessels relaxed and open and discourages clotting. In pulmonary arterial hypertension there is too little of it, so the lung arteries stay narrowed. Epoprostenol replaces this action strongly, relaxing and widening the lung arteries and lowering the pressure the heart must pump against. Because it lasts only minutes, a steady continuous infusion is needed to keep its effect going; if the infusion stops, the benefit is lost very quickly, which is why interruptions are dangerous.
Company & origin
Originated / developed by: GlaxoSmithKline (originator).
The original prostacyclin medicine, given by continuous infusion in the UK by specialist centres for severe pulmonary arterial hypertension.
Practical use
How to take Epoprostenol
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given as a continuous infusion through a permanent line using a portable pump, set up and managed by your specialist centre.
- Never let the infusion stop or run out, as the effect lasts only minutes and stopping suddenly can be dangerous — keep the pump running and carry spares.
- Follow the strict sterile handling and dressing care you are taught for the line, to lower the risk of infection.
- Respond promptly to pump alarms and know who to contact in an emergency, day or night.
- Report fever, chills, redness or pain around the line, or sudden worsening of breathlessness, urgently.
Weighing it up
Advantages & disadvantages of Epoprostenol
Advantages
- A powerful and well-established treatment that can help even severe pulmonary arterial hypertension.
- Continuous delivery gives a steady, around-the-clock effect on the lung arteries.
- Long experience in specialist centres supports its use in advanced disease.
Disadvantages
- Must be given as a non-stop infusion through a permanent line, with a portable pump to manage.
- Stopping it suddenly is dangerous because its effect lasts only minutes, risking a rebound worsening.
- The permanent line carries a real risk of serious bloodstream infection.
Practical use
Good to know
Epoprostenol is among the most specialist of pulmonary hypertension treatments, set up and run entirely by an expert centre. The most important safety point is that it must never be stopped or interrupted abruptly, because its effect disappears within minutes and the lung pressure can rebound to a dangerous level; patients and carers are trained to keep the pump running, carry spares and respond quickly to alarms. Because it is delivered through a permanent line into a large vein, there is a real risk of line infections, which can be serious, so careful sterile handling of the line is essential. Common effects come from its blood-vessel action — flushing, jaw pain, headache, leg or foot ache and low blood pressure.
Who should not take it / use with caution
- People who cannot safely manage a permanent infusion line and pump, even with support, may not be suitable.
- It is avoided in people at high risk of bleeding, because it affects how blood clots.
- It is used with great caution in those with very low blood pressure or certain heart conditions.
Monitoring
- Close monitoring of blood pressure, heart rate and the response to treatment.
- Careful watch for line infections, with checks of the line site and prompt action on fever.
- Regular specialist review of breathlessness, exercise capacity and overall response.
Side effects
- Flushing, jaw pain, headache and aching in the legs or feet are common.
- Low blood pressure, nausea, diarrhoea and a fast heartbeat.
- Line-related problems, especially infection at or in the line, which can be serious.
Key interactions
- Adds to the blood-pressure-lowering effect of other medicines, increasing the risk of dizziness.
- Adds to the effect of blood-thinning and anti-platelet medicines, raising bleeding risk.
- Used alongside other pulmonary hypertension medicines under specialist supervision.
Available as: A solution given by continuous intravenous infusion through a permanent line, using a portable pump.
Answers
Epoprostenol: frequently asked questions
Why does it have to be given continuously?
Epoprostenol works for only a few minutes in the body, so a non-stop infusion is needed to keep its effect on the lung arteries going.
What happens if the infusion stops?
Stopping suddenly is dangerous, as the effect disappears within minutes and the lung pressure can rebound; you are trained to keep the pump running and respond quickly.
How serious is the line infection risk?
Because the medicine goes through a permanent line into a large vein, infections can occur and can be serious, so careful sterile handling and prompt reporting of fever are essential.
Why do I get jaw pain and flushing?
These come from epoprostenol widening blood vessels and are common, especially early on; tell your team if they are troublesome.
Who looks after this treatment?
It is set up and managed entirely by a specialist pulmonary hypertension centre, who train you and your carers to run the pump safely.
Authoritative sources
- BNF
- NICE CKS
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