Veletri (epoprostenol) is used to treat pulmonary arterial hypertension (PAH) in patients with severe disease (WHO Functional Class III and IV). Like Flolan, it is a synthetic form of prostacyclin and is given as a continuous intravenous (IV) infusion via a central line (a catheter into a large vein, usually in the chest).

The key difference between Veletri and Flolan is that Veletri's formulation is stable at room temperature for longer periods (up to 72 hours depending on the concentration and diluent), compared to Flolan which requires ice packs and must be discarded after 8 to 24 hours. This improved stability makes Veletri more convenient for some patients, particularly in warmer climates or during travel.

Veletri must be given as a continuous IV infusion 24 hours a day via a central venous catheter. Even brief interruptions in the infusion can cause sudden and severe worsening of PAH symptoms, which can be life-threatening.

You will be trained by specialist nurses to prepare the solution and manage the pump at home. The dose is calculated individually and adjusted over time.

Never adjust the dose yourself without guidance from your PAH team.

An interruption in the infusion is a medical emergency. If your pump alarm sounds, the line disconnects, or the solution runs out, contact your PAH specialist or hospital immediately. Keep emergency contact numbers readily available at all times.

An overdose causes a severe drop in blood pressure, dizziness, flushing, and slowing of the heart rate. Seek emergency medical attention immediately.

• Unreconstituted vials: store at room temperature (below 25°C)
• Reconstituted solution: can be used at room temperature without ice packs, for up to 48 to 72 hours depending on the preparation method
• Follow your PAH nurse's specific instructions for preparation, storage, and replacement of cassettes
• Keep out of reach of children

Side effects are the same as for Flolan (epoprostenol) as it contains the same active ingredient.

Very common side effects:

• Flushing (warmth and redness)
• Headache
• Jaw pain (especially when eating)
• Nausea and diarrhoea
• Low blood pressure
• Muscle or joint pain

Serious complications:

• Central line infections: the catheter site must be kept clean and monitored daily
• Sepsis: report fever or chills immediately
• Sudden worsening of PAH if the infusion is interrupted

Your PAH team will monitor your response and side effects closely.

• Anticoagulants (warfarin): epoprostenol has anti-platelet effects, increasing bleeding risk
• Blood pressure-lowering medicines: additive blood pressure lowering effects

Always inform all healthcare providers you are on continuous IV epoprostenol.

What is the difference between Veletri and Flolan?

Both Veletri and Flolan contain the same active ingredient, epoprostenol, and work in exactly the same way. The difference is in the formulation. Veletri uses a different pH stabiliser that allows the prepared solution to remain stable at room temperature for up to 72 hours, without requiring ice packs during the infusion. Flolan must be kept cold and is discarded after 8 to 24 hours. For patients in warmer climates or who want to travel, Veletri's room-temperature stability offers a practical advantage.

Can I ever go back to a subcutaneous or oral PAH medicine?

In some patients who have stabilised well on IV epoprostenol, transitioning to an alternative route or medicine may be considered. However, this is complex and must be done extremely carefully with close medical supervision, as the risk of clinical deterioration is real. Never attempt to reduce or stop your IV epoprostenol without a formal plan agreed with your PAH specialist.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.