Epoprostenol

CLINICAL USE

Vasodilation and inhibition of platelet aggregation without prolonging bleeding timeAlternative to heparin in haemodialysis Treatment of peripheral vascular disease and pulmonary hypertension

DOSE IN NORMAL RENAL FUNCTION

2–50 ng/kg/minute, adjusted according to responseDialysis anticoagulation: 4 ng/kg/minute starting 10–15 minutes before and continuing during dialysis via the arterial line, adjusted according to response (range: 0.5–12 ng/kg/minute)

PHARMACOKINETICS

Molecular weight :352.5

%Protein binding :No data

%Excreted unchanged in urine : 40–90 (as drug + metabolites)

Volume of distribution (L/kg) :0.357–1.015

half-life – normal/ESRD (hrs) :2–6 minutes/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in normal renal function

HD :Unknown dialysability. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsIncreased hypotensive effect with ‘acetate’ dialysis

ADMINISTRATION

Reconstition

500 microgram vial with diluent provided gives solution of 10 micrograms/mL. Can be diluted further

Route

IV or into blood supplying dialyser

Rate of Administration

Via CRIP

Comments

Complicated dosing schedule – check calculations carefullyInfusion rate may be calculated by the following formula:Dose rate (mL/hr) Dosage (ng/kg/min) × body wt (kg) × 60 Concentration of infusion (ng/mL) (usually 10 000 ng/mL)

OTHER INFORMATION

Monitor BP and heart rate. Reduce dose if patient becomes hypotensive. Cardiovascular effects cease 30 minutes after stopping the infusionSome patients may exhibit allergic reaction to buffer solution used to reconstitute epoprostenolSolution retains 90% potency for 12 hours after dilutionThe concentrated solution should be filtered using the filter provided in the pack

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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