Effectiveness, Safety, and Economic Comparison of Inhaled Epoprostenol Brands, Flolan and Veletri, in Acute Respiratory Distress Syndrome

Ann Pharmacother. 2020 May;54(5):434-441. doi: 10.1177/1060028019888853. Epub 2019 Nov 15.


Background: No previous studies exist examining 2 inhaled epoprostenol formulations in an acute respiratory distress syndrome (ARDS) patient population. Objective: The study aim was to evaluate a formulary conversion from inhaled Flolan to Veletri to determine the impact on effectiveness, safety, and cost in patients with ARDS. Methods: This was a single-center, retrospective, matched cohort observational study at a tertiary care academic medical center. Patients included were mechanically ventilated, adult patients with ARDS receiving inhaled Flolan or Veletri for ≥1 hour in the intensive care unit. Results: A total of 132 patients were included in the matched cohort. There was no difference detected in change in partial pressure of arterial O2/fraction of inspired O2 (PaO2/FiO2) ratio after 1 hour of therapy between the inhaled Flolan and Veletri groups (27.2 ± 46.2 vs 30 ± 68 mm Hg, P = 0.78). Significant differences in secondary outcomes included incidence of hypotension (83% vs 95.5%, P = 0.04) and thrombocytopenia (9.1% vs 29.5%, P < 0.01) in the inhaled Flolan and Veletri groups, respectively, with no difference in cost per duration of therapy (P = 0.29). Conclusions and Relevance: There was no difference in the change in PaO2/FiO2 ratio after 1 hour of therapy between inhaled Flolan and Veletri in an ARDS patient population. The formulary conversion from inhaled Flolan to Veletri was likely justified.

Keywords: adult respiratory distress syndrome; clinical pharmacology; prostaglandins; pulmonary; respiratory failure.

Publication types

  • Observational Study

MeSH terms

  • Administration, Inhalation
  • Adult
  • Drug Compounding
  • Epoprostenol / administration & dosage
  • Epoprostenol / adverse effects
  • Epoprostenol / therapeutic use*
  • Female
  • Humans
  • Hypotension / chemically induced
  • Middle Aged
  • Pharmaceutic Aids / chemistry
  • Respiratory Distress Syndrome / drug therapy*
  • Retrospective Studies
  • Thrombocytopenia / chemically induced
  • Vasodilator Agents / administration & dosage
  • Vasodilator Agents / adverse effects
  • Vasodilator Agents / therapeutic use*


  • Pharmaceutic Aids
  • Vasodilator Agents
  • Epoprostenol