Epoprostenol

Epoprostenol is a synthetic analogue of prostacyclin (prostacyclin I2, PGI2). It activates prostacyclin receptors on vascular smooth muscle and platelets, increasing cyclic AMP, which promotes vasodilation and inhibits platelet aggregation. Through these actions, epoprostenol lowers pulmonary vascular resistance and can improve cardiac output in certain patients with pulmonary arterial hypertension.

The primary indication is the treatment of severe pulmonary arterial hypertension (PAH) to improve symptoms, exercise capacity, and survival. It is used as continuous intravenous infusion in adults and select pediatric patients; it is sometimes employed in combination with other PAH therapies in refractory cases. It has also been studied in other forms of pulmonary hypertension, but its main approved use remains PAH.

Epoprostenol is given by continuous IV infusion via a central venous catheter. It has an extremely short half-life, roughly 3 to 6 minutes, so uninterrupted delivery is essential; interruption can cause rapid deterioration. Some preparations require cold chain storage and protection from light, while newer formulations may offer improved stability at room temperature.

Common adverse effects include headache, flushing, jaw pain, nausea, diarrhea, hypotension, tachycardia, and infusion-site reactions. Because prostacyclin inhibits platelet aggregation, epoprostenol can increase bleeding risk. Prolonged use or high doses may cause edema. Abrupt discontinuation can lead to rebound pulmonary hypertension; careful dose tapering is necessary when stopping therapy.

Epoprostenol represents a potent, short-acting vasodilator and antiplatelet agent used in PAH management as a continuous infusion. It requires specialized equipment, monitoring, and careful handling due to its instability and the need for uninterrupted delivery.