[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Pulmonary arterial hypertension drugs (endothelin receptor antagonists and prostacyclins)](https://durgical.com/en/pharmacology/classes/pulmonary-arterial-hypertension-drugs/) › Epoprostenol

# Epoprostenol

## Pulmonary arterial hypertension drugs (endothelin receptor antagonists and prostacyclins)?

Pulmonary arterial hypertension drugs (endothelin receptor antagonists and prostacyclins)

## High alert?

An error with this medicine can cause serious harm: double checks and protocols are used.

Synthetic prostacyclin given as a continuous intravenous infusion for severe pulmonary arterial hypertension; it acts for only minutes.

Updated Nov 1, 2026

## Quick facts

**Group**
[Pulmonary arterial hypertension drugs (endothelin receptor antagonists and prostacyclins)](https://durgical.com/en/pharmacology/classes/pulmonary-arterial-hypertension-drugs/)

**Target**
Prostacyclin receptor (IP receptor)

**Used for**
Pulmonary arterial hypertension

**Key effects**
Flushing and headache · Jaw pain · Nausea

**Monitor**
Blood pressure · Catheter site for infection

**ATC**
B01AC09

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**Prostacyclin receptor (IP receptor)**Epoprostenol

ⓘ No structure with epoprostenol is available: the figure shows treprostinil, a prostacyclin analogue that occupies the same site of the human IP receptor (cryo-EM, with its G protein).

**Target in 3D:** Prostacyclin receptor (IP receptor). PDB structure 8X7A (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8X7A) · Drag to rotate · pinch to zoom

Epoprostenol is prostacyclin (PGI2) itself. It activates the IP receptor on pulmonary artery smooth muscle, a Gs-coupled receptor that raises cyclic AMP; protein kinase A lowers intracellular calcium and relaxes the vessels, and cAMP also slows smooth-muscle growth. It dilates both pulmonary and systemic arteries, increases cardiac output and inhibits platelet aggregation. It is hydrolysed in blood within minutes.

- Epoprostenol (prostacyclin) binds the IP receptor of vascular smooth muscle
- Gs activates adenylyl cyclase and cyclic AMP rises
- Calcium falls: pulmonary and systemic arteries relax
- Pulmonary resistance falls and platelets aggregate less

## Indications

- Pulmonary arterial hypertension (WHO group 1), especially advanced disease, to improve exercise capacity [Pulmonary hypertension and cor pulmonale →](https://durgical.com/en/conditions/pulmonary-hypertension-and-cor-pulmonale/)

## Adverse effects

### Common

- Flushing and headache
- Jaw pain
- Nausea, vomiting and diarrhoea
- Musculoskeletal pain and flu-like symptoms
- Anxiety and nervousness

### Serious (rare, important)

- Rebound pulmonary hypertension if the infusion is interrupted or reduced suddenly
- Catheter-related infection and sepsis
- Hypotension
- Bleeding, because it inhibits platelets
- Pulmonary oedema

## Contraindications

- Heart failure due to severe left ventricular systolic dysfunction
- Pulmonary oedema
- Hypersensitivity to epoprostenol or related compounds

## Key interactions

**Diuretics, antihypertensives and other vasodilators**
Additive fall in blood pressure

**Anticoagulants and antiplatelet drugs**
Higher bleeding risk

**Digoxin**
Digoxin levels may rise, important in patients prone to toxicity

## What is monitored

- Blood pressure, heart rate and symptoms at every dose change
- Infusion pump function and line patency
- Catheter site for infection; temperature
- Signs of rebound: sudden breathlessness, dizziness, weakness

## Administration and safety

- Continuous intravenous infusion through a central venous catheter with an ambulatory pump
- Never mixed with other parenteral medicines or solutions, before or during the infusion
- The infusion must never be stopped or its rate reduced abruptly
- Aseptic technique for reconstitution, line changes and catheter care
- Some formulations are sensitive to light and temperature; preparation follows the product's instructions

## Pregnancy and breastfeeding

Limited reports have not shown a clear drug-related risk; untreated pulmonary arterial hypertension carries serious risks for mother and fetus.

## Nursing care

- Treat any pump alarm or line problem as an emergency: even a brief interruption can cause rebound
- Do not give other drugs or fluids through the epoprostenol line
- Check blood pressure and heart rate after every rate change
- Inspect the catheter site and watch for fever
- Teach the patient and family pump care, sterile technique and what to do if the infusion stops

## Pharmacokinetics

**Metabolism**
Rapid spontaneous hydrolysis at blood pH plus enzymatic breakdown, to inactive products

**Elimination**
Metabolites mainly in urine

**Half-life**
A few minutes in human blood

**Onset and duration**
Within minutes; the effect also wears off within minutes if the infusion stops

## Memory aid

Epoprostenol is a «minutes» drug: Minutes to act, Minutes to wear off, so the line and the pump are Mandatory and never stop.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is epoprostenol given as a continuous infusion?

It is hydrolysed in blood within minutes; only a continuous central infusion keeps its effect.

## What happens if the epoprostenol pump stops?

Rebound pulmonary hypertension can develop quickly, with breathlessness, dizziness and collapse.

## Which receptor and second messenger does epoprostenol use?

The prostacyclin IP receptor, coupled to Gs, which raises cyclic AMP.

## Which are two typical side effects of prostacyclin therapy?

Flushing, headache, jaw pain, diarrhoea or nausea.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/epoprostenol/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**High alert**
An error with this medicine can cause serious harm: double checks and protocols are used.

## Connections

## Related drugs 3

- [Treprostinil](https://durgical.com/en/pharmacology/treprostinil/)
- [Bosentan](https://durgical.com/en/pharmacology/bosentan/)
- [Sildenafil](https://durgical.com/en/pharmacology/sildenafil/)

## Related conditions 1

- [Pulmonary hypertension and cor pulmonale](https://durgical.com/en/conditions/pulmonary-hypertension-and-cor-pulmonale/)

[← Back to the class: Pulmonary arterial hypertension drugs (endothelin receptor antagonists and prostacyclins)](https://durgical.com/en/pharmacology/classes/pulmonary-arterial-hypertension-drugs/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - EPOPROSTENOL injection, powder, lyophilized, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=47f64fcd-cbf7-457a-9548-661fb10ff7e0) (DailyMed (U.S. National Library of Medicine), 2026); [Epoprostenol: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a622042.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [RCSB PDB - 8X7A: Treprostinil bound Prostacyclin Receptor G protein complex](https://www.rcsb.org/structure/8X7A) (RCSB Protein Data Bank, 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/epoprostenol/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/epoprostenol/