Successful withdrawal of long-term epoprostenol therapy for pulmonary arterial hypertension

Chest. 2003 Oct;124(4):1612-5.


Background: IV epoprostenol treatment of pulmonary arterial hypertension (PAH) has been believed to require an indefinite duration of therapy

Objective: To describe the successful discontinuation of long-term epoprostenol therapy in four patients

Design: Case reports

Setting: Outpatient clinic, tertiary-care hospital

Patients: Four patients with acutely nonvasoreactive, World Health Organization (WHO) functional class IV PAH received long-term epoprostenol therapy. All patients subsequently demonstrated normalization of pulmonary arterial pressures on epoprostenol treatment. These patients were selected for epoprostenol withdrawal

Intervention: Down-titration and discontinuation of epoprostenol

Results: All four patients were safely transitioned from epoprostenol to oral therapies and have maintained WHO functional class I-II for a mean of 11 months (range, 8 to 16 months). The duration of epoprostenol therapy prior to discontinuation averaged 5.7 years (range, 2.4 to 13.5 years)

Conclusion: Epoprostenol may sufficiently reverse the pathogenic process in select patients with PAH to allow a transition to less complex and less invasive treatment modalities.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / administration & dosage*
  • Epoprostenol / administration & dosage*
  • Female
  • Humans
  • Hypertension, Pulmonary / drug therapy*
  • Middle Aged
  • Remission Induction
  • Time Factors


  • Antihypertensive Agents
  • Epoprostenol