Flolan (epoprostenol)
Also marketed as Veletri. An approved treatment for Pulmonary Arterial Hypertension.
The same compound appears under different names depending on the context. Here is how to identify Epoprostenol wherever you encounter it, plus the key facts at a glance.
- Generic name
- Epoprostenol
- Brand names
- Flolan, Veletri
- Drug class
- Prostacyclin analog
- Manufacturer
- Actelion, a Johnson & Johnson company (Veletri); generic epoprostenol from several makers. GSK's Flolan is discontinued in the US.
- How it's taken
- Delivered as a continuous intravenous infusion 24 hours a day, 7 days a week through a central venous catheter and a portable pump.
The first drug ever approved for PAH and still considered the gold standard for the most severe cases. Delivered through a continuous IV pump, epoprostenol dramatically improved survival in a disease that was previously untreatable.
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Where Epoprostenol fits
Gold standard for severe PAH and the only therapy shown to improve survival in a randomized trial. Requires continuous IV infusion via portable pump, typically reserved for advanced disease.
How Epoprostenol works
Epoprostenol is a synthetic version of prostacyclin, a molecule the body naturally produces to keep blood vessels relaxed and prevent blood clots. In PAH, prostacyclin production is impaired. Epoprostenol replaces what's missing, directly relaxing the smooth muscle around pulmonary arteries, lowering pressure, and preventing the blood clots that worsen the disease.
Mechanism: Synthetic prostacyclin that directly dilates pulmonary and systemic blood vessels and inhibits platelet aggregation
Side effects and safety
Jaw pain, headache, flushing, nausea, diarrhea, and leg cramps are very common. The continuous IV line carries risks of bloodstream infections and catheter-related complications. Abrupt interruption can cause life-threatening rebound pulmonary hypertension. Dose adjustments must be done carefully.
This is not a complete list of side effects. Talk to your doctor or pharmacist about what to expect and when to seek medical attention.
Taking Epoprostenol
Delivered as a continuous intravenous infusion 24 hours a day, 7 days a week through a central venous catheter and a portable pump. Veletri can be used at room temperature; depending on the concentration, a mixed pump reservoir lasts 24 to 72 hours. Brand Flolan is discontinued in the US; if you use generic epoprostenol, follow your specialty pharmacy's storage and mixing instructions for that product. Patients and caregivers must be trained in sterile preparation and pump operation.
Availability and cost
Generic versions may be available at a lower cost. Ask your pharmacist.
Available in generic form, though the continuous IV infusion pump system and specialized pharmacy services add significant costs beyond the drug itself.
Help paying for Flolan
Pick your insurance to see which help fits. Drugmaker copay cards can't be used with Medicare, Medicaid or TRICARE; charity funds are the usual route there.
- Insurance and case manager help
J&J withMe explains insurance and points to cost-help options for VELETRI; hours Mon-Fri, 8AM-8PM ET.
For: private insurance, Medicare, Medicaid, no insurance · source - Other support
For VELETRI, J&J withMe refers patients to independent foundations (e.g. The Assistance Fund, Good Days) and government programs.
For: private insurance, Medicare, no insurance · source
Good to know: No VELETRI copay card or free-drug program is listed on J&J's official pages. J&J's 2026 pulmonary hypertension patient assistance guide lists only OPSUMIT, OPSYNVI and UPTRAVI, not VELETRI. Generic epoprostenol is available.
- From a charity · HealthWell FoundationPulmonary Hypertension (Medicare Access) fundOpen
Pays for: Copays, premiums or other treatment costs. Medicare patients only.
- From a charity · TotalAssist (formerly PAN Foundation)Pulmonary Hypertension fundOpen
Pays for: Out-of-pocket costs for approved medications, up to $9,500 per year. Requires health insurance (any kind).
- From a charity · The Assistance FundPulmonary Hypertension fundWaitlist
Pays for: Copays, coinsurance, deductibles and other health-related expenses.
The foundation says: “WAITLIST — Accepting Waitlist Patients. TAF is currently accepting requests to join the enrollment waitlist for this program. Waitlists a…”
Clinical trial results
The landmark 1996 trial (81 patients, 12 weeks) found that median 6-minute walk distance rose from 315 to 362 meters on epoprostenol while it fell in the conventional therapy group, with lower pressure in the lung arteries. All 8 deaths in the study were in the conventional therapy group. Epoprostenol was the first therapy to show a survival benefit in PAH in a randomized trial.
Development history
Approved in 1995 as the first PAH-specific therapy. Transformed PAH from a rapidly fatal diagnosis to a manageable chronic disease. Veletri (room-temperature stable formulation) was approved in 2008, making home use more practical. GSK's original brand, Flolan, has since been discontinued in the US. Despite newer oral therapies, IV epoprostenol remains the treatment of choice for the sickest PAH patients.
Explore Pulmonary Arterial Hypertension trials
Other Pulmonary Arterial Hypertension treatments
Common questions about Epoprostenol
▸What is Epoprostenol (Flolan)?
The first drug ever approved for PAH and still considered the gold standard for the most severe cases. Delivered through a continuous IV pump, epoprostenol dramatically improved survival in a disease that was previously untreatable.
▸How does Epoprostenol work?
Epoprostenol is a synthetic version of prostacyclin, a molecule the body naturally produces to keep blood vessels relaxed and prevent blood clots. In PAH, prostacyclin production is impaired. Epoprostenol replaces what's missing, directly relaxing the smooth muscle around pulmonary arteries, lowering pressure, and preventing the blood clots that worsen the disease.
▸What are the side effects of Epoprostenol?
Jaw pain, headache, flushing, nausea, diarrhea, and leg cramps are very common. The continuous IV line carries risks of bloodstream infections and catheter-related complications. Abrupt interruption can cause life-threatening rebound pulmonary hypertension. Dose adjustments must be done carefully.
▸How is Epoprostenol taken?
Delivered as a continuous intravenous infusion 24 hours a day, 7 days a week through a central venous catheter and a portable pump. Veletri can be used at room temperature; depending on the concentration, a mixed pump reservoir lasts 24 to 72 hours. Brand Flolan is discontinued in the US; if you use generic epoprostenol, follow your specialty pharmacy's storage and mixing instructions for that product. Patients and caregivers must be trained in sterile preparation and pump operation.
▸Is Epoprostenol FDA approved?
Yes, Epoprostenol (Flolan) is FDA approved (1995) for the treatment of Pulmonary Arterial Hypertension.
▸Why is epoprostenol still used when oral PAH drugs exist?
Epoprostenol remains the gold standard for the most severely ill PAH patients (WHO Functional Class IV) because it is the only PAH therapy that has demonstrated a survival benefit in a randomized controlled trial. Its potency and reliability make it irreplaceable for patients in right heart failure or with rapidly progressing disease. Oral therapies are typically started first, but patients who deteriorate despite multiple oral medications are often escalated to IV epoprostenol.
▸What is the difference between Flolan and Veletri?
Both contain epoprostenol for IV infusion. Brand Flolan, made by GSK, is now discontinued in the US, so current options are Veletri and generic epoprostenol. Veletri is made to stay stable at room temperature; depending on the concentration, a mixed pump reservoir can be used for 24 to 72 hours. Storage and mixing rules can differ between products, so follow the instructions from your specialty pharmacy for the version you use.
▸What happens if the IV pump stops?
Abrupt interruption of epoprostenol can cause life-threatening rebound pulmonary hypertension, where the pulmonary artery pressure spikes suddenly. This is a medical emergency that can lead to right heart failure and death within hours. Patients must always have backup pump equipment, spare drug, and an emergency plan. Central line complications (infection, clotting, disconnection) are the most common causes of accidental interruption.
▸Can patients live a normal life on continuous IV epoprostenol?
Many patients achieve a good quality of life on IV epoprostenol despite the demands of a continuous infusion. Patients carry a small portable pump in a waist pack or shoulder bag and learn to prepare the medication and care for their central line. Swimming and certain contact sports are restricted, but many patients work, travel, and maintain active lifestyles. The burden of care is significant, and dedicated caregiver support is often needed, especially initially.
▸Is generic epoprostenol available?
Yes. Generic epoprostenol for injection is available, though the overall treatment cost remains substantial because of the continuous infusion pump system, specialized compounding pharmacy services, central line maintenance, and nursing support required for safe administration.