Flolan or epoprostenol is a widely used
PAH treatment which injects a vasodilator- an agent that relaxes
the pressure of the blood vessels in the lungs, reducing the
workload on the heart. Flolan is synthetic (man-made) form of
a naturally occurring molecule in our bodies called prostaglandin.
This synthetic substance is called Prostacyclin.
Flolan was one of the first and most effective form of treating
Pulmonary Arterial Hypertension (PAH). Flolan works by imitating
the natural prostacyclin produced by the body to keep blood vessels
healthy by removing the build up of lipids, lowering blood pressure.
People respond to increased doses of Flolan which dilate, or
open up, blood vessels in the lungs and throughout the body.
This Flolan (Prostacyclin) also appears to prevent blood clots
from forming. Flolan has been studied in clinical trials, and
was the first FDA approved drug treatment designed specifically
for PAH.
Flolan is administered intravenously directly into the bloodstream through a surgically implanted catheter by a portable, battery-operated pump. The pump is worn attached to a belt around the waist or carried in a small shoulder pack. Since the drug lasts only 3-5 minutes it must constantly be infused: it is slowly and continuously pumped into the body through the permanent catheter placed in a vein in the neck or chest. The pump is filled daily with the mixed Flolan solution. This solution needs to be chilled and the pack needs ice. Many patients have difficulty with the pump and Flolan treatment because is is cumbersome, and requires maintenance and diligent attention to detail. Another Synthetic Prostacyclin called Remodulin works in a similar manner, it is injected into the skin, but uses a much smaller pump because the molecule does not need to be cooled.
Flolan is a lifetime therapy which requires uninterrupted infusion into the body because of its short effect-3 to 5 minute effect. The drug is thus delivered 24 hours a day. The drug is very expensive and is used only after a positive diagnosis of advanced PAH. Because of the complexity of administering Flolan, patients use special health care services to learn about administering the treatment. Companies that distribute Flolan offer home health care services including infusion and nursing.
There is no set dose proven to be effective. The dose of Flolan used is based on the amount of relief it provides the patient of their PAH symptoms and the patient's ability to handle Flolan side effects. The dose will increase during a patient's therapy in order to remain effective; no maximum dose has been demonstrated.
Flolan therapy has been credited with raising the life expectancy of patients with PAH by many years and has been extremely effective in improving numerous patients lives.
The downside and side effects of Flolan Treatment
Side effects can include jaw pain, headache, flushing, nausea, diarrhea, and vomiting. Interruption of Flolan can be life-threatening, even a brief interruption can result in a sudden reoccurrence of symptoms. The indwelling central I.V. line, the catheter through which the pump delivers the Flolan needs a high degree of maintenance and infections can be serious.
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