Flolan Compatibility with Normal Saline
No, Flolan (epoprostenol) should NOT be diluted with normal saline (NS) for standard continuous infusion therapy. Epoprostenol must be reconstituted with its specific alkaline glycine buffer diluent to maintain stability and proper pH 1.
Critical Preparation Requirements
Epoprostenol requires an alkaline buffer (glycine) for dissolution and stability 1. The drug is:
- Unstable at acidic pH 2
- Stable at room temperature for only 8 hours after reconstitution 1
- Requires cooling with ice packs during continuous infusion 1
- Must be changed daily due to limited stability 1
Exception: Treprostinil (Remodulin) Compatibility
In contrast, treprostinil (a different prostacyclin analog) CAN be diluted with normal saline, though with significant limitations 3:
When using NS as diluent for treprostinil:
- Storage limit: 4 hours at room temperature OR 24 hours refrigerated
- Administration limit: 48 hours at 40°C
- This is substantially shorter than the 14-day stability achieved with high-pH glycine diluent
Preferred diluents for treprostinil include:
- Sterile Diluent for Remodulin
- Sterile Diluent for Flolan or Epoprostenol (high-pH glycine diluent)
- These allow 14 days storage at room temperature 3
Clinical Implications
Using normal saline with Flolan would compromise drug stability and patient safety. The short half-life of epoprostenol (3-5 minutes) 1 means any degradation or interruption can lead to:
- Rebound pulmonary hypertension
- Rapid clinical deterioration (within 20-30 minutes) 2
- Potential death 2
Always use the manufacturer-supplied sterile diluent containing glycine buffer for Flolan preparation. This maintains the alkaline pH necessary for drug stability during the required continuous intravenous infusion 1, 2.