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What it is:
Flolan®
is a form of prostacyclin. It was approved by the FDA in 1995, and
is produced by Glaxo Wellcome, Inc. It is a potent vasodilator that
relaxes the blood vessels in the lungs and slows the process of scarring
and cell growth within the lung’s blood vessels, which
prevents further narrowing. It also assists in increasing cardiac
output and oxygen saturation. It improves exercise tolerance and
prolongs
survival in patients with PH. Although Flolan® was once used as a
bridge to transplantation, it has now emerged as an alternative to
transplant.
How it is Administered:
Flolan® is administered intravenously directly into the bloodstream.
A surgically implanted
catheter is placed in a vein in the chest and leads directly
into the heart. A portable, battery-operated pump administers
the Flolan®. The pump is worn attached to a belt around the waist
or carried in a small shoulder pack. A thin plastic cannula connects
the pump to the catheter. Since the drug lasts only 3-5 minutes,
it must constantly be infused: it is slowly and continuously pumped
into the body through the vein in the chest.
Maintenance and Routines:
Flolan® is a powder in a glass vial. The powder must be mixed with
a special solution called diluent.
Flolan® is mixed fresh daily and stored in a plastic cassette, which
is attached to the pump. The pump is refilled with a fresh cassette
every day. Once mixed, Flolan® must be kept refrigerated, so small
ice packs are usually placed in the shoulder pack with the pump.
The dosage of Flolan® changes
frequently, especially in the early stages of treatment. The PH
physician determines the dosage, and a dosage chart is usually prepared
for the patient.
Side Effects:
Side effects of Flolan® can include jaw pain, headache, flushing,
nausea, diarrhea, and vomiting. Central line infections
occur occasionally, though many patients never experience a
line infection.
A line infection frequently requires hospitalization, and sometimes
replacement of the central line.
Cost:
Flolan® can cost upward of $75,000 per year, often more. Because
it is considered a treatment rather than a prescription drug,
insurance
companies handle this differently than a prescription drug policy. It
is usually covered by insurance plans, with prior approval before
treatment is begun. Medicare also covers Flolan® treatment.
Summary:
Flolan® is an effective treatment for many people with PH, but it
is complex and labor-intensive to administer. It requires
that all members of a patient’s care team understand the drug,
its side effects, and its handling in order to assure safety and
effectiveness.
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