Patient leaflet - Epoprostenol Sodium 0.5 mg powder and solvent for solution for infusion
1. What Epoprostenol is and what it is used for
Epoprostenol Sodium Powder and Solvent for Solution for Infusion contains the active substance epoprostenol which belongs to a group of medicines called prostaglandin, which stops blood from clotting and widens the blood vessels.
Epoprostenol is used to treat a lung condition called ‘pulmonary arterial hypertension’. This is where the pressure is high in the blood vessels in the lungs. Epoprostenol widens the blood vessels to lower the blood pressure in the lungs.
Epoprostenol is used to prevent blood clotting during kidney dialysis in emergency situations when heparin cannot be used.
2. What you need to know before you use Epoprostenol
Do not use Epoprostenol:
- if you are allergic to epoprostenol or any of the other ingredients of this medicine (listed in section 6).
- if you have heart failure.
- if you start to develop a build-up of fluid in your lungs causing breathlessness after starting this treatment.
If you think any of these apply to you, don’t use Epoprostenol until you have checked with your doctor.
Warnings and precautions
Before you are given Epoprostenol your doctor needs to know:
- if you have any problems with bleeding.
- if you are on a controlled sodium diet.
Skin damage at the injection site
Epoprostenol is injected into a vein. It is important that the medicine does not leak out of the vein into the surrounding tissue. If it does, the skin could be damaged. The symptoms of this are:
- tenderness
- burning
- stinging
- swelling
- redness.
This may be followed by blistering and shedding of the skin. While you are being treated with Epoprostenol it is important that you check the injection area.
Contact the hospital immediately for advice if the area becomes sore, painful or swollen or you notice any blistering or shedding.
Effect of Epoprostenol on blood pressure and heart rate
Epoprostenol can cause your heart to beat faster or slower. Also your blood pressure can become too low. While you are being treated with Epoprostenol your heart rate and blood pressure will be checked. The symptoms of low blood pressure include dizziness and fainting.
Tell your doctor if you get these symptoms. Your dose may need to be reduced or your infusion stopped.
Other medicines and Epoprostenol
Tell your doctor if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription.
Some medicines may affect how Epoprostenol works, or make it more likely that you’ll have side effects. Epoprostenol can also affect how some other medicines work if taken at the same time. These include:
- medicines used to treat high blood pressure
- medicines used to prevent blood clots
- medicines used to dissolve blood clots
- medicines to treat inflammation or pain (also called ‘NSAIDs’)
- digoxin (used to treat heart disease).
Tell your doctor or pharmacist if you are taking any of these.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine as your symptoms could worsen during pregnancy.
It is not known whether the ingredients of Epoprostenol can pass into breast-milk. You should stop breast-feeding your child during treatment with Epoprostenol.
Driving and using machines
Your treatment may have an effect on the ability to drive or use machinery.
Don’t drive or use machines unless you’re feeling well.
Epoprostenol contains Sodium
Epoprostenol, 0.5 mg Sodium Powder and Solvent for Solution for Infusion
When Epoprostenol is reconstituted with 50 ml of Glycine buffer diluent, the final injection contains 30.0 mg, equivalent to 1.5 % of the WHO recommended maximum daily intake of 2 g sodium for an adult.
Epoprostenol contains Sodium
Epoprostenol Sodium 1.5 mg Powder and Solvent for Solution for Infusion
When Epoprostenol is reconstituted with 50 ml of Glycine buffer diluent, the final injection contains 30.07 mg, equivalent to 1.5 % of the WHO recommended maximum daily intake of 2 g sodium for an adult.
3. How to use Epoprostenol
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
Your doctor will decide how much Epoprostenol is right for you. The amount you are given is based on your body weight, and your type of illness. Your dose may be increased or decreased depending on how well you respond to treatment.
Epoprostenol is given by slow infusion (drip) into a vein.
Pulmonary arterial hypertension
Your first treatment will be given to you in a hospital. This is because your doctor needs to monitor you and find the best dose for you.
You will start with an infusion of Epoprostenol. The dose will be increased, until your symptoms are relieved, and any side effects are manageable. Once the best dose has been found, a permanent tube (line) will be fitted into one of your veins. You can then be treated using an infusion pump.
Kidney dialysis
You will be given an infusion of Epoprostenol for the duration of your dialysis.
Using Epoprostenol at home (only for treatment of Pulmonary Arterial Hypertension)
If you are treating yourself at home, your doctor or nurse will show you how to prepare and use Epoprostenol. They will also advise you how to stop treatment if necessary. Stopping Epoprostenol must be done gradually. It is very important that you follow all their instructions carefully.
Epoprostenol comes as a powder in a glass vial. Before use, the powder needs to be dissolved in the liquid provided. The liquid does not contain a preservative. If you have any of the liquid left over, it must be thrown away.
Looking after the injection line
If you have been fitted with a ‘line’ into a vein it is very important to keep this area clean, otherwise you could get an infection. Your doctor or nurse will show you how to clean your ‘line’ and the area around it. It is very important that you follow all of their instructions carefully.
If you use more Epoprostenol than you should
Seek urgent medical attention if you think you have used or been given too much Epoprostenol. Symptoms of overdose may include headache, nausea, vomiting, fast heart rate, warmth or tingling, or feeling like you might pass out (feeling faint/dizziness).
If you forget to use Epoprostenol
Do not take a double dose to make up for a forgotten dose.
If you stop using Epoprostenol
Stopping Epoprostenol must be done gradually. If the treatment is stopped too quickly you may get serious side effects, including dizziness, feeling weak and breathing difficulties. If you have problems with the infusion pump or injection line that stops, or prevents treatment with Epoprostenol, contact your doctor, nurse or hospital immediately.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist or nurse.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Tell your doctor or nurse immediately, as these may be signs of infection of the blood or low blood pressure or serious bleeding:
- You feel that your heart is beating faster, or you have chest pain or shortness of breath.
- You feel dizzy or feel faint, especially on standing.
- You have fevers or chills.
- You have more frequent, or longer periods of bleeding.
Talk to your doctor or pharmacist or nurse about any other side effects, including those not listed in this leaflet.
Very common side effects (may affect more than 1 in 10 people):
- headache
- redness of your face
- feeling sick (nausea)
- being sick (vomiting)
- diarrhoea
- jaw pain
- pain
Common side effects (may affect up to 1 in 10 people):
- infection of the blood (septicaemia)
- bleeding at various sites and bruising more easily than normal, for example from the nose or gums
- feeling anxious, feeling nervous
- heart beating faster
- slow heart beat
- stomach discomfort or pain
- rash
- joint pain
- pain at the injection site
- chest pain
- low blood pressure
Common side effects that may show up in blood tests
- decrease in the number of blood platelets (cells that help the blood to clot)
Uncommon side effects (may affect up to 1 in 100 people):
- dry mouth
- sweating
Rare side effects (may affect up to 1 in 1,000 people):
- infection at the injection site
Very rare side effects (may affect up to 1 in 10,000 people):
- feeling agitated
- pale skin
- redness at the injection site
- feeling tired, weak
- feeling of tightness around the chest
- overactive thyroid gland
- blockage of the injection catheter
Other side effects
It is not known how many people are affected by:
- enlarged or overactive spleen
- build up of fluid in the lungs (pulmonary oedema)
- increase in sugar (glucose) in the blood
- too much pumping of blood from the heart leading to shortness of breath, fatigue, swelling of the legs and abdomen due to fluid build-up, persistent cough
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.
You can also report side effects directly via the Yellow Card Scheme (www.mhra.gov.uk/yellowcard) or search for MHRA Yellow Card in Google play or Apple App store. By reporting side effects you can help provide more information on the safety of this medicine.
5. How to store Epoprostenol
Keep this medicine out of the sight and reach of children.
Powder for solution for infusion: Keep the vial in the outer carton in order to protect from light.
Solvent: Do not freeze.
Do not use this medicine after the expiry date which is stated on the label and carton after EXP. The expiry date refers to the last day of that month.
The reconstituted solution should not be used if particles are present. Glycine buffer diluent contains no preservative, consequently a vial should be used once only and then discarded.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Contents of the pack and other information
What Epoprostenol Sodium Powder and Solvent for Solution for Infusion contains
Epoprostenol Sodium 0.5 mg Powder and Solvent for Solution for Infusion:
- The active substance is epoprostenol (as epoprostenol sodium). Each vial contains epoprostenol sodium equivalent to 0.5 mg epoprostenol.
One ml of reconstituted concentrate solution contains epoprostenol (as epoprostenol sodium) 10 000 nanogrammes.
Epoprostenol Sodium 1.5 mg Powder and Solvent for Solution for Infusion
- The active substance is epoprostenol (as epoprostenol sodium). Each vial contains epoprostenol sodium equivalent to 1.5 mg epoprostenol.
One ml of reconstituted concentrate solution contains epoprostenol (as epoprostenol sodium) 30 000 nanogrammes.
- The other ingredients are: Mannitol, Glycine, Sodium Chloride, Sodium Hydroxide (only for pH adjustment).
The solvent for Epoprostenol Sodium Powder and Solvent for Solution for Infusion is composed of sodium chloride, glycine, sodium hydroxide (only for pH adjustment) and water for injection.
What Epoprostenol Sodium Powder and Solvent for Solution for Infusion looks like and contents of the pack
Powder for solution for infusion: 15 ml colourless glass type I vials closed with rubber stopper and aluminium/propylene cap
Solvent: 55 ml colourless glass type I vials closed with rubber stopper and aluminium/propylene cap.
Pack sizes:
- 1, 2, 3, 4, 5, 6 or 10 packs containing 1 vial with powder for solution for infusion, 1 vial with solvent and 1 filter;
- 1, 2, 3, 4, 5, 6 or 10 packs containing 1 vial with powder for solution for infusion, 2 vials with solvent and 1 filter.
The powder needs to be reconstituted and diluted before infusion.
Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder:
Hexal AG, Industriestrasse 25, 83607 Holzkirchen, Germany
Manufacturer:
Lek Pharmaceuticals d.d., Verovškova 57, 1526 Ljubljana, Slovenia
This leaflet was last revised in 06/2018.
Other sources of information
<---------------------------------------------------------------------------------------------------
The following information is intended for medical or healthcare professionals only
- 7. INFORMATION FOR HEALTHCARE PROFESSIONALS
Renal Dialysis
There is only one pack available for use in renal dialysis:
One 0.5 mg powder vial and one solvent vial
Reconstitution:
- 1. Use only the solvent provided for reconstitution
- 2. Withdraw approximately 10mL of the solvent into a sterile syringe, inject it into the vial containing 0.5 mg freeze-dried Epoprostenol powder and shake gently until the powder has dissolved
- 3. Draw up the resulting Epoprostenol solution into the syringe, re-inject it into the remaining volume of the solvent and mix thoroughly.
This solution is now referred to as the concentrated solution and contains 10,000 nanogram per mL Epoprostenol. Only this concentrated solution is suitable for further dilution prior to use. When 0.5 mg Epoprostenol powder is reconstituted with 50 mL of the solvent, the final injection has a pH of approximately 10.5 and a sodium ion content of approximately 54.7 mg.
Dilution:
The concentrated solution is normally further diluted before use. It may be diluted with sodium chloride 0.9% w/v solution, provided a ratio of 6 volumes of sodium chloride 0.9% w/v solution to 1 volume of concentrated solution is not exceeded e.g. 50 mL of concentrated solution further diluted with a maximum of 300 mL sodium chloride 0.9% w/v solution.
Other common intravenous fluids are unsatisfactory for the dilution of the concentrated solution as the required pH is not attained. Epoprostenol solutions are less stable at low pH.
To dilute the concentrated solution, draw it up into a larger syringe and then attach the sterile filter provided to the syringe.
Dispense the concentrated solution directly into the chosen infusion solution using firm but not excessive pressure; the typical time taken for filtration of 50 mL of concentrated solution is 70 seconds. Mix well.
The filter unit must be used once only and then discarded.
When reconstituted and diluted as directed above, Epoprostenol infusion solutions have a pH of approximately 10 and will retain 90% of their initial potency for approximately 12 hours at 25°C.
Calculation of infusion rate:
The infusion rate may be calculated from the following formula:
Infusion rate = dosage (nanogram/kg/min) x bodyweight (kg)
(mL/min) concentration of solution (nanogram/mL)
Infusion rate (mL/h) = Infusion rate (mL/min) x 60
For administration using a pump capable of delivering small volume constant infusions, suitable aliquots of concentrated solution may be diluted with sterile sodium chloride 0.9% w/v solution.
Pulmonary arterial hypertension
There are four packs available for use in the treatment of pulmonary arterial hypertension, as follows:
One 0.5 mg powder vial and one or two solvent vials and a filter unit.
One 1.5 mg powder vial and one or two solvent vials and a filter unit.
One 0.5 mg powder vial.
One 1.5 mg powder vial.
Not all pack sizes are available in all markets.
Initially, a pack containing solvent must be used. During chronic therapy with Epoprostenol the final concentration of solution may be increased by the addition of a further 0.5 mg or 1.5 mg vial of freeze-dried Epoprostenol.
Only vials of the same amount as that included in the initial starter pack may be used to increase the final concentration of solution.
Reconstitution:
1.Use only the solvent provided for reconstitution.
2.Withdraw approximately 10mL of the solvent into a sterile syringe, inject the contents of the syringe into the vial containing Epoprostenol powder and shake gently until the powder has dissolved.
3.Draw up the resulting Epoprostenol solution into the syringe, re-inject it into the remaining volume of the solvent and mix thoroughly.
This solution is now referred to as the concentrated solution and contains either 10,000 (for the 0.5 mg strength) or 30,000 nanogram per mL Epoprostenol (for the 1.5 mg strength). Only this concentrated solution is suitable for further dilution prior to use. When 0.5 mg Epoprostenol powder is reconstituted with 50 mL of the solvent, the final injection has a pH of approximately 10.5 and a sodium ion content of approximately 54.8 mg.
Dilution:
Epoprostenol may be used either as concentrated solution or in a diluted form for the treatment of pulmonary arterial hypertension. Only the solvent provided may be used for the further dilution of reconstituted Epoprostenol. Sodium chloride 0.9% w/v solution must not be used when Epoprostenol is to be used for the treatment of pulmonary arterial hypertension.
To dilute the concentrated solution, draw it up into a larger syringe and then attach the sterile filter provided to the syringe.
Dispense the concentrated solution directly into the solvent using firm but not excessive pressure; the typical time taken for filtration of 50 mL of concentrated solution is 70 seconds. Mix well.
The filter must be used once only and then discarded.
Concentrations commonly used in the treatment pulmonary arterial hypertension are as follows:
- 5,000 nanogram/mL – One vial containing 0.5 mg Epoprostenol reconstituted and diluted to a total volume of 100 mL in solvent.
- 10,000 nanogram/mL – Two vials containing 0.5 mg Epoprostenol reconstituted and diluted to a total volume of 100 mL in solvent.
- 15,000 nanogram/mL – One vial containing 1.5 mg Epoprostenol reconstituted and diluted to a total volume of 100 mL in solvent.
Calculation of infusion rate:
The infusion rate may be calculated from the following formula:
Infusion rate = dosage (nanogram/kg/min) x bodyweight (kg)
(mL/min) concentration of solution (nanogram/mL)
Infusion rate (mL/h) = Infusion rate (mL/min) x 60
Higher infusion rates, and therefore, more concentrated solutions may be necessary with long-term administration of Epoprostenol.
Special precautions for storage
Don’t store above 25ºC.
Keep container in the outer carton to protect from light.
Keep dry.
Do not freeze.
Any cold pouch used must be capable of maintaining the temperature of the reconstituted solution.
Store between 2 and 8ºC for the full administration period.
Reconstitution and dilution should be carried out immediately prior to use. The solvent contains no preservative; consequently a vial should be used once only and then discarded.