Drug Database
EP

epoprostenol (Caripul)

✓ Approved

Actelion · PTGIR · Small Molecule

What is epoprostenol?

epoprostenol is a small molecule developed by Actelion. It is approved for therapeutic indications via injectable (others) or intravenous (iv).

Drug Profile

Brand NamesCaripul
CompanyActelion
Drug ClassSmall Molecule
Molecular TargetPTGIR
RouteInjectable (Others), Intravenous (IV)
StatusApproved
Sources: ClinicalTrials.gov, Actelion

Mechanism of Action

Molecular Targets

epoprostenol acts on 1 molecular target:

PTGIRprostaglandin I2 receptor (IP, PRIPR)
Want deeper analysis?Noah AI can explain complex mechanisms and compare to similar drugs.

Therapeutic Indications

epoprostenol is developed for 1 unique indication across 1 therapeutic area.

Therapeutic AreaConditionPhase
Respiratory, thoracic and mediastinal disordersPulmonary hypertension✓ Approved

Related Research Articles

PubMedCritical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine2026-09-06

The association between documented right ventricular dysfunction and in-hospital mortality in mechanically ventilated critically ill patients receiving a noradrenaline infusion: A retrospective observational cohort study.

Tan Li H LH, Paul Eldho E, Simpson Alex A, Marasco Silvana S et al.

To determine the documentation of right ventricular dysfunction (RVD) in mechanically ventilated patients receiving a noradrenaline infusion, and to assess the association with in-hospital mortality, length of stay (LOS) and treatment intensity. This single-centre, retrospective, observational cohort study included patients admitted to the intensive care unit (ICU) between January 2020 and December 2023, with elevated serum lactate levels, who received invasive mechanical ventilation and an intravenous noradrenaline infusion, within the first 7 days. Exposure was defined on the basis of documentation of RVD in the medical record; e.g. those with RVD vs those without RVD. The primary outcome was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital LOS, organ support modalities, and the utilisation of echocardiography. Comparison between groups utilised logistic and linear regression models. Of 1234 patients included in the study, 273 had documented RVD (22.1%). There was no difference in crude in-hospital mortality (RVD, 24.9% vs no RVD, 23.6% p = 0.66) between groups. Risk-adjusted in-hospital (odds ratio [OR]: 1.65: 1.13-2.41, p = 0.01) and ICU mortality (OR: 1.88: 1.26-2.81, p = 0.002) were greater in those with documented RVD. Median ICU (13.4 vs 10.2 days, p = 0.001) and hospital (25.1 vs 22.5 days, p = 0.002) LOS were significantly longer in the RVD group. A greater number of interventions were provided in those with RVD, including: inhaled nitric oxide (39.6% vs 7.8%, p < 0.001), epoprostenol (1.8% vs 0.1%, p < 0.001), milrinone infusion (77.3% vs 23.6%, p < 0.001), continuous renal replacement therapy (48.7% vs 25.8%, p < 0.001), and extracorporeal membrane oxygenation (33.7% vs 10.4%, p < 0.001). The median number of transthoracic (TTE) or transoesophageal echocardiography (TOE) was 3 (interquartile range [IQR]: 1-4) in those with RVD, compared to 1 (IQR: 1-2) in those without RVD (p < 0.001). Approximately 1 in 4 patients who were mechanically ventilated and receiving noradrenaline had documented RVD, which was associated with a higher risk-adjusted in-hospital mortality, longer LOS, and greater treatment intensity.

PMID 42699670
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PubMedCHEST pulmonary2026-09-03

Real-World Experience of Midodrine in Hospital Setting in Pulmonary Arterial Hypertension.

Giese Noah N, Safdar Zeenat Z, Mulumudi Anisha A, Momin Sarah S et al.

Pulmonary arterial hypertension (PAH), a progressive disease, is characterized by increased pulmonary vascular resistance (PVR) and leads to right ventricular failure and premature death. PAH therapies aim to reduce PVR; however, these treatments as vasodilators may also result in reduced systemic vascular resistance and mean arterial pressure (MAP), leading to clinical or symptomatic hypotension. Low MAP can limit the administration of optimal dosage of PAH drugs. Midodrine, an oral alpha-1 adrenergic agonist, as a promising intervention, can potentially increase mean MAP and improve tolerance to PAH therapies. Does the use of midodrine improve MAP and allow for simultaneous uptitration of PAH therapy while hospitalized? A retrospective analysis of 433 patients treated at Houston Methodist Lung Center was undertaken between January 2005 and September 2022. Of these, 57 patients were prescribed midodrine during their hospital stay. We matched 57 patients 1:1 with propensity score matching between patients with PAH not given midodrine (control patients) based on age, sex, World Health Organization functional class, B-type natriuretic peptide, and 6-minute walk distance. Among hospitalized patients with PAH, those receiving midodrine were more likely to undergo uptitration of their PAH medications compared with those not receiving midodrine (n = 30 vs n = 17, respectively; P < .05). Patients on midodrine during hospitalization received higher doses of epoprostenol (P < .001), treprostinil (P < .05), and selexipag (P < .05). Additionally, no adverse effects attributable to midodrine were reported. This study, to our knowledge the first large-scale analysis of PAH data, investigated the use of midodrine in hospitalized patients with PAH. In this single-center study, we share real-world experience of using midodrine to mitigate systemic hypotension, thereby facilitating the uptitration of PAH-targeted therapies.

PMID 42688414
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PubMedCureus2026-08-22

The Silent Threat: Unmasking Combined Post- and Pre-capillary Pulmonary Hypertension (CpcPH) in an Elderly Patient With Heart Failure With Preserved Ejection Fraction (HFpEF).

Bhatt Prashant R PR, Gupta Ashish A, Ray Anuva A, Sharma Ashutosh A et al.

Pulmonary hypertension (PH) is a progressive disorder associated with substantial morbidity and mortality, and its diagnosis may be delayed in older adults with multiple cardiopulmonary comorbidities because symptoms frequently overlap with more common cardiovascular and pulmonary conditions. Combined post- and pre-capillary pulmonary hypertension (CpcPH) is a severe phenotype characterized by pulmonary vascular remodeling superimposed on elevated left-sided filling pressures and is associated with worse outcomes than isolated post-capillary PH. We report the case of a 77-year-old man with chronic hypoxic respiratory failure, heart failure with preserved ejection fraction (HFpEF), chronic atrial fibrillation, coronary artery disease, and obstructive sleep apnea who presented with progressive exertional dyspnea, syncope, and increasing oxygen requirements. His symptoms were initially attributed to HFpEF and coexisting cardiopulmonary conditions. Serial transthoracic echocardiography demonstrated progressive right ventricular enlargement, worsening right ventricular systolic function, interventricular septal flattening, and progressively increasing right ventricular systolic pressure (RVSP) from 46.6 to 87 mmHg. Right heart catheterization confirmed severe combined post- and pre-capillary pulmonary hypertension with a pulmonary capillary wedge pressure of 16 mmHg and pulmonary vascular resistance of 10.7 Wood units. Comprehensive evaluation excluded alternative causes of pre-capillary pulmonary hypertension. Because the severity of pulmonary vascular disease appeared disproportionate to isolated HFpEF-related pulmonary hypertension, the patient underwent multidisciplinary evaluation at a specialized pulmonary hypertension center, where an individualized treatment strategy with intravenous epoprostenol and sildenafil was initiated, resulting in improvement in functional status and oxygen requirements during hospitalization. This case highlights the diagnostic challenges of CpcPH in patients with HFpEF and multiple cardiopulmonary comorbidities. Progressive right ventricular remodeling, syncope, and worsening oxygen requirements should prompt consideration of pulmonary hypertension when clinical deterioration appears disproportionate to the underlying cardiopulmonary disease. Early recognition, serial echocardiographic assessment, timely right heart catheterization, and referral to specialized pulmonary hypertension centers are essential for establishing an accurate diagnosis and guiding individualized management.

PMID 42631330
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PubMedBMJ open2026-08-20

Women in healthy transition deep phenotyping cohort study protocol (KiSO-DP): a within-participant multidisciplinary longitudinal cohort study across the menopausal transition.

Tamariz-Ellemann Andrea A, Kleis-Olsen Ann-Sofie AS, Andersen Amalie Bach AB, Thomsen Laura Bachmann LB et al.

Cardiovascular disease risk accelerates in women after the menopausal transition, coinciding with the cessation of endogenous oestrogen production. The accompanying decline in vascular function is considered a key driver of this shift. However, longitudinal studies investigating the impact and time course of changes in cardiovascular and skeletal muscle function during the menopausal transition and in the subsequent years are warranted. The Women in Healthy Transition (KiSO) Deep Phenotyping (DP) study is a multidisciplinary prospective longitudinal cohort study with the objective to determine cardiovascular changes from the late reproductive stage through 20 years of postmenopause. The primary outcome is quantification of endothelium-dependent vascular function. Secondary outcomes include evaluating endothelium-independent vascular function, conduit artery endothelial function, mitochondrial function, circulating skeletal muscle vascular markers and sociological factors. The overall aim is to provide deep mechanistic, longitudinal insight into menopause-related vascular ageing to inform future cardiovascular disease prevention strategies in women. 200 healthy women will be examined at the late reproductive stage and at 1, 3, 5, 10 and 20 years postmenopause. At each test round vascular function is evaluated using invasive intra-arterial infusion protocols, including acetylcholine and epoprostenol infusions, as well as flow-mediated dilation. Additional measures include arterial blood pressure, arterial compliance, echocardiography, cardiorespiratory fitness, whole-blood rheology, dual-energy X-ray absorptiometry-derived body composition, circulating reproductive and cardiometabolic biomarkers, skeletal muscle biopsies for assessment of mitochondrial capacity and proteins related to skeletal muscle and cardiometabolic health. Menopausal staging is determined using Stages of Reproductive Aging Workshop (STRAW)+10 criteria supported by follicle-stimulating hormone, anti-Müllerian hormone concentrations and antral follicle count. The study is conducted in accordance with the Declaration of Helsinki and has been approved by the regional ethics committee: Ethics Committee of Copenhagen (H-22025286) and is registered with ClinicalTrial.gov (NCT05647876). Findings from the study will be disseminated through publications in peer-reviewed scientific journals, presentations at national and international conferences and through PhD theses. The results are expected to provide novel insights into the development of vascular and skeletal muscle function across the menopausal transition and may contribute to future strategies for prevention of cardiovascular disease in women. NCT05647876.

PMID 42624590
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PubMedPulmonary circulation2026-08-14

Transitions From Parenteral Prostacyclin Analogues to Selexipag in Patients With Pulmonary Arterial Hypertension.

Kuebel Dalton J DJ, Collins Adele R AR, Jose Arun A, Guido Maria R MR et al.

Pulmonary arterial hypertension (PAH) is a progressive illness that may require therapy with parenteral prostacyclin pathway agents (PPA) (epoprostenol and treprostinil). These parenteral PPA's are continuous ambulatory infusions that require a high level of skill and knowledge to maintain safety and effectiveness. Depending on the clinical context, transition to oral prostacyclin receptor agonist therapy (selexipag) is sometimes pursued. To prevent abrupt withdrawal from parenteral PPA's, overlap transitions are typically used. This report describes 35 inpatient, rapid transitions from parenteral PPA's to oral selexipag. Planned hospital admissions for transition were common (n = 27, 77%), and all patients successfully transitioned without a return to parenteral PPA's in the immediate post-transition period. Most patients transitioned due to difficulties with current parenteral PPA therapy (n = 20, 57%), followed by an improved clinical status on parenteral PPA therapy (n = 8, 23%). The median length of transition was 36 h (IQR 24-48 h) and hospital stay was 3 days (IQR 2-6 days). Following transition, the cohort demonstrated stability in PAH-specific risk scores and functional status. All patients survived to outpatient pulmonary hypertension follow up (median 5.5 weeks, IQR 1.4-9.6 weeks), and the majority were alive at 1-year post-transition (n = 32, 91%). Based on these results, we conclude that transition from parenteral PPA's to selexipag can be done in the inpatient setting safely, quickly, and effectively.

PMID 42598408
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PubMedJHLT open2026-08-10

Inhaled pulmonary vasodilators in pulmonary hypertension: Perioperative use and clinical considerations.

Klingbeil Rebecca R, Hjalmarsson Clara C, Colvin Bailey B, Kozarek Katherine K et al.

Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic condition associated with increased perioperative morbidity and mortality, particularly in patients undergoing cardiac or high-risk non-cardiac surgery. Inhaled pulmonary vasodilators (iPVs) offer a targeted strategy to reduce pulmonary vascular resistance (PVR) and improve right ventricular (RV) function while minimizing systemic hypotension. Traditional vasodilators such as nitroglycerin and sodium nitroprusside lack pulmonary specificity and can exacerbate systemic hypotension. Inhaled agents including nitric oxide (NO), epoprostenol (iEPO), iloprost, milrinone (iMIL) and levosimendan provide selective pulmonary vasodilation with more favorable hemodynamic profiles. This narrative review summarizes current evidence and clinical considerations for the use of iPVs in the perioperative management of PH and discusses pharmacokinetics, delivery mechanisms, adverse effects, and logistical considerations for these agents. New emerging PH therapies are included based on early clinical trial data as they have the potential to impact perioperative care in the future. Overall, iPVs represent a valuable tool in the perioperative care of patients with PH. Continued research is needed to refine clinical protocols, evaluate emerging agents, and establish outcome-based evidence for their routine use.

PMID 42572609
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