Flolan (epoprostenol) is a medicine used to treat pulmonary arterial hypertension (PAH), a serious condition where the blood pressure in the arteries supplying the lungs is abnormally high. This makes the right side of the heart work much harder than normal, eventually leading to heart failure if untreated.

Epoprostenol is a synthetic form of a natural substance called prostacyclin, which relaxes and widens blood vessels in the lungs and also prevents blood clots from forming.

Flolan is used in patients with severe PAH (WHO Functional Class III and IV) who have not responded well to other treatments.

Flolan is given as a continuous infusion directly into a vein through a central line (a catheter that goes into a large vein, usually in the chest). It must be running continuously, 24 hours a day, every day.

Because it is very short-acting, even a brief interruption in the infusion can cause a sudden and severe worsening of PAH symptoms. You will be trained by specialist nurses to manage the pump and prepare the solution at home.

The dose is calculated individually and adjusted over time based on your response and tolerance. Never adjust the dose yourself without guidance from your PAH team.

Flolan must not be interrupted. If your pump alarm sounds, the line becomes disconnected, or the solution runs out, you should contact your PAH specialist or hospital immediately. You should have emergency contact numbers readily available at all times.

An overdose causes a sudden drop in blood pressure, dizziness, flushing, nausea, and slowing of the heart rate. If you suspect you have received too much, seek emergency medical attention immediately.

• Unreconstituted powder: store in a refrigerator between 2°C and 8°C
• The prepared solution must be kept cold using ice packs in a medication pouch during the infusion
• The prepared solution must be discarded after 8 to 24 hours depending on the preparation method
• Keep out of reach of children

Your PAH nurse will teach you the correct preparation and storage routine.

Side effects are common and often related to the blood vessel-dilating effects of epoprostenol.

Very common side effects:

• Flushing (warmth and redness)
• Headache
• Jaw pain (especially when eating)
• Nausea and diarrhoea
• Low blood pressure (dizziness, lightheadedness)
• Muscle or joint pain

Serious complications:

• Central line infections: the catheter site must be kept clean and monitored daily for redness, swelling, or discharge
• Sepsis: a serious infection that can be life-threatening. Report fever or chills immediately
• Sudden worsening of PAH if the infusion is interrupted

Many side effects improve as your body adjusts to the dose. Report any new or worsening symptoms to your PAH team.

Epoprostenol can interact with many medicines.

Important interactions include:

• Anticoagulants (blood thinners such as warfarin): epoprostenol has anti-platelet effects, increasing bleeding risk when combined with anticoagulants
• Blood pressure-lowering medicines: the combination can cause excessive drops in blood pressure

Always inform all healthcare providers (including dentists and surgeons) that you are on continuous Flolan infusion.

Can I travel while on Flolan?

Travel is possible but requires careful planning. You will need to carry enough medication, ice packs, and pump supplies. Airlines and security checkpoints will need to be notified in advance. Your PAH centre will help you plan travel safely.

What happens if my pump stops working?

A pump malfunction is a medical emergency. You should always have a backup pump and emergency supplies. Contact your PAH team or go to the nearest emergency department immediately if the pump fails.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.