Flolan or epoprostenol simulates prostaglandin, a type of molecule that acts as a vasodilator that is naturally produced by the body. Prostacyclin, the synthetic form of this molecule that is in Flolan- acts as an inhibitor of platelet aggregation, the process in which platelets combine at the site of vascular injury to block blood flow. It is believed that an abnormally low ratio of prostacyclin in relation to thromboxane A2, a molecule that stimulates platelet aggregation, may be partially responsible for the development of primary pulmonary hypertension. Prostacyclin analogs (imitators) such as Flolan have been used to treat primary pulmonary hypertension and so far seem to support this belief. In clinical trials, Flolan has been shown to improve survival rate, exercise capacity, and hemodynamics (blood circulation) and to date is one of only two FDA approved drugs treatments for PPH.

Now intravenous Flolan infusions are used to treat patients who fail to respond to oral calcium antagonists such as Nifedipine, and may be used either as long-term therapy or as a precursor to transplantation. It has been shown to both improve blood circulation and increase exercise tolerance in PPH patients who have been unresponsive to conventional therapy.

A downside to the treatment is that Flolan expires quickly and must be infused continuously by an automated syringe pump and through a permanent catheter. Also, the delivery system is complex and requires patients to learn the techniques of sterile preparation, operation of the pump, and care of the intravenous catheter. In some cases this type of infusion may create serious complications (e.g., sepsis, thromboembolism, or syncope) related to the use of an implanted central vein catheter. Remodulin (Treprostinil sodium), a synthetic stable form of prostacyclin might be a viable alternative for patients suffering from complication as a result of Flolan use. Remodulin lasts longer than Flolan and can be infused subcutaneous (under the skin). This method of infusion greatly reduces the risk of sepsis infection and hospitalization.


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Pulmonary Hypertension Treatments

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