The dose of epoprostenol is based on body weight. The recommended starting dose is 2 ng per kilogram of bodyweight per minute. Your doctor will monitor your response to the medication and may adjust the dose based on how you respond.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

Epoprostenol is injected intravenously (into a vein) by a procedure called continuous intravenous infusion. This means that the medication will be flowing into your body on a constant basis. You will need to have a special device inserted into your vein for the medication to be given (called a central venous catheter).

Sometimes, this medication will be given in the hospital by a health care professional. At other times, it may be given to you while you are at home or outside the hospital. In this situation, you will have a special pump that will help deliver the medication into your vein. A health care professional will teach you (and your caregiver or family member) how to prepare the medication and how to use the pump. Only use the tubing supplied to you with your medication or by your health care professional.

It is important this medication be used exactly as recommended by your doctor. If your infusion of epoprostenol is interrupted for any reason, contact your doctor to discuss what you should do.

Store the unmixed vials of medication and diluents at room temperature (between 15°C to 25°C), protect it from light, and keep out of the reach of children. Do not freeze.

Each vial of sterile lyophilized powder contains epoprostenol sodium equivalent to 0.5 mg (500,000 ng) or 1.5 mg (1,500,000 ng) epoprostenol in a 10 mL vial. Nonmedicinal ingredients: L-arginine, sucrose, and sodium hydroxide (for pH adjustment).

Do not use epoprostenol if you:

• are allergic to epoprostenol, or any ingredients of the medication
• are allergic to any medications with a similar chemical structure to epoprostenol
• develop pulmonary edema (fluid in the lungs) when starting the medication
• have congestive heart failure

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• diarrhea
• dizziness
• dry mouth
• flushing
• headache
• heartburn
• increased sensitivity to touch
• increased sweating
• jaw discomfort
• lightheadedness
• nausea
• pain, redness, or rash at the site of infusion
• tiredness
• vomiting
• weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abdominal pain
• agitation
• anxiety
• bone and joint pain
• change in heart rate (fast or slow)
• difficulty breathing
• nervousness
• signs of an enlarged spleen (e.g., stomach fullness or pain, difficulty digesting a large meal)
• signs of bleeding (e.g., bloody, black, or tarry stools; nosebleeds; blood in urine; coughing blood; bleeding gums; cuts that don’t stop bleeding; vomiting blood or material that looks like coffee grounds)
• signs of intravenous line blockage (e.g., dizziness, weakness, shortness of breath)
• swelling around the stomach
• symptoms of an intravenous line infection (e.g., redness, tenderness, swelling, or pus at the infusion site)
• symptoms of low blood pressure (e.g., fainting, severe dizziness)
• symptoms of overactive thyroid gland (e.g., nervousness, rapid heartbeat, hand tremor, weight loss, and problems sleeping)
• symptoms of too much blood pumping from the heart (e.g., persistent cough, shortness of breath, fatigue, swelling of the legs and abdomen)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
• sudden onset of fever
• symptoms of a blood infection (e.g., fever, headache, fatigue)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Bleeding: Epoprostenol prevents platelets in the blood from sticking together, which can put you at risk for bleeding. If you experience any signs or symptoms of bleeding (e.g., black and tarry stools, blood in the urine, easy bruising, cuts that won't stop bleeding), contact your doctor immediately. While you are taking this medication, your doctor should closely monitor your platelet counts with blood tests.

Drowsiness/reduced alertness: This medication may cause drowsiness or dizziness. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how this medication affects you.

Infection: Since this medication is given intravenously through a central venous catheter, this increases your risk of infections in the blood, which can be fatal. If you notice any signs or symptoms such as a sudden onset of fever, fatigue, or headache, contact your doctor immediately.

Giving the medication intravenously also puts you at increased risk of infections at the infusion site. Contact your doctor as soon as possible if you notice symptoms such as redness, tenderness, swelling, or pus at the infusion site.

Low blood pressure (hypotension): Epoprostenol works to reduce the pressure in the blood vessels by dilating the blood vessels. People being treated with epoprostenol should avoid situations that can further dilate their blood vessels, such as sitting in saunas, hot baths, and sunbathing.

Stopping the medication: When epoprostenol is stopped suddenly, or the dose is decreased by a large amount, symptoms of pulmonary hypertension may occur. If your epoprostenol infusion is stopped abruptly for some reason and you develop symptoms such as pain when breathing (dyspnea), dizziness, weakness, and fatigue, contact your doctor immediately.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if epoprostenol passes into breast milk. If you are breast-feeding and taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: The safety of using this medication has not been established for seniors. Seniors may be at greater risk for side effects such as kidney, liver, or heart problems and should be monitored closed.

There may be an interaction between epoprostenol and any of the following:

• acetylsalicylic acid
• aldesleukin
• aldosterone antagonists (e.g., eplerenone, spironolactone)
• aliskiren
• alpha-blockers (e.g., alfuzosin, doxazosin, tamsulosin)
• alpha-agonists (e.g., clonidine, methyldopa)
• amiodarone
• angiotensin converting enzyme (ACE) inhibitors (e.g., captopril, enalapril, ramipril)
• angiotensin II receptor blockers (e.g., irbesartan, losartan, valsartan)
• antipsychotics (e.g., clozapine, olanzapine, quetiapine, risperidone)
• apixaban
• apomorphine
• barbiturates (e.g., butalbital, phenobarbital)
• beta-blockers (e.g., atenolol, propranolol, timolol)
• brimonidine
• bromocriptine
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• clomipramine
• clopidogrel
• dabigatran
• diazoxide
• digoxin
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, indapamide, spironolactone)
• edoxaban
• general anesthetics (medications used to put people to sleep before surgery)
• guanfacine
• heparin
• hydralazine
• imipramine
• levodopa
• low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• nabilone
• nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, ketorolac, naproxen)
• obinutuzumab
• pentoxifylline
• phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pramipexole
• prasugrel
• riociguat
• rivaroxaban
• ropinirole
• rotigotine
• sacubitril
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin-norepinephrine reuptake inhibitors (SNRIs; desvenlafaxine, duloxetine, venlafaxine)
• ticagrelor
• tizanidine
• tretinoin
• vilazodone
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.