Pulmonary, obstetric and electrolyte infusions
Epoprostenol (inhaled) (Flolan) drip
Flolan, Veletri
Dosing
| Start | 50 ng/kg/min by ideal (predicted) body weight, by continuous vibrating mesh nebulization (range 10–50). At 30,000 ng/mL that is 0.1 mL/h per kg (Li 2021). Fixed-rate setups hold about 8 mL/h with a weight-matched concentration (375 ng/mL per kg: 26,250 ng/mL for 70 kg; Siobal 2003) |
|---|---|
| Titrate | Wean by 10 ng/kg/min every 30–60 minutes while oxygenation and hemodynamics hold (Li 2021), then off from 10 |
| Maximum | 50 ng/kg/min (unit protocols; no guideline sets a dose) |
| Common bags | 1,500 mcg in 50 mL (30 mcg/mL); 750 mcg in 50 mL (15 mcg/mL); 500 mcg in 50 mL (10 mcg/mL) |
| Dose units | ng/kg/min |
Line and administration
- Nebulizer at the humidifier inlet (ventilator or high-flow cannula), no HME; drug deposits clog expiratory filters, so change them on schedule
- Aerogen Solo takes at most 12 mL/h (Aerogen): at 50 ng/kg/min only the 30,000 ng/mL bag fits most adults; weaker bags suit lower doses
- Never stop abruptly: prime the next syringe before this one runs out and keep it running on transport
- IV epoprostenol for PAH is a separate therapy: own central line, never stopped, flushed or bolused; keep the home dose and pump and call the PH team
Watch for
- Rebound after any interruption: PA pressure rise, hypoxemia, hypotension (6% of courses, one arrest; Block 2021)
- Hypotension, especially in shock
- Bleeding with low platelets or anticoagulation (inhibits platelet aggregation)
Epoprostenol: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- ARDSAdjuncts: what, when and the evidence: Inhaled NO or epoprostenol: Rescue for oxygenation or RV failure only: Better P/F at 24 h, no survival gain, more renal failure (Cochrane 2016)
- Cardiorespiratory Look-Alikes and Special PatientsSpecial physiology and equipment: PAH on IV or SC prostacyclin: Pump stopped: rebound pulmonary hypertension, RV failure, syncope: Restart with the backup pump; avoid hypoxia and hypotension; small boluses only; no nitro; PH center
- LVAD BasicsSelection, implant and the early postoperative course: The first week is about the right ventricle. Unloading pulls the septum leftward and removes its help to RV contraction while pump flow raises venous return to an RV still facing high pulmonary pressures; it dilates, the LV under-fills, and flow and PI fall with a high CVP. INTERMACS counts right heart failure as needing an RVAD, prolonged inh
- Pulmonary EmbolismSupporting the failing RV: Dobutamine for low output once MAP holds; inhaled NO or epoprostenol as a bridge
- Common EMS MedicationsChest pain and breathing: Ask about PDE-5 inhibitors: no nitro within 24 h of sildenafil or vardenafil, or 48 h of tadalafil (ACC/AHA 2025); many protocols use 48 h for all. Avoid with IV epoprostenol or treprostinil.
- EMT By-Complaint Quick PagesChest pain: the 12-lead and the drugs: Nitroglycerin: the patient's own 0.4 mg SL, repeated per protocol only while SBP stays over 100; never within 48 h of sildenafil, vardenafil or tadalafil, or with IV epoprostenol or treprostinil (NASEMSO). See prehospital-stroke-stemi for the right-ventricular infarct caution.
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Other pulmonary, obstetric and electrolyte infusions
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.