Subcutaneous Treprostinil in Pulmonary Arterial Hypertension: Practical Considerations

J Heart Lung Transplant. 2010 Nov;29(11):1210-7. doi: 10.1016/j.healun.2010.06.013. Epub 2010 Sep 19.

Abstract

Treprostinil, which is available for subcutaneous (SC) and intravenous (IV) administration, has demonstrated efficacy in increasing exercise capacity, reducing signs and symptoms of pulmonary arterial hypertension (PAH), and improving cardiopulmonary hemodynamics in patients with PAH; however, the infusion site pain commonly experienced with SC treprostinil has limited its use. Prospective and observational clinical studies have shown that the dose of SC treprostinil can be escalated at a higher rate than described in early clinical trials to achieve symptom relief, in part because of favorable tolerability of treatment and the apparent dose independence of site pain. In addition, pain management protocols that include non-pharmacologic and pharmacologic (i.e., topical and systemic) approaches provide analgesic relief from infusion site pain. With experience, physicians and patients have recognized that some infusion sites are better than others, and the frequency of site rotation can be reduced to improve tolerability. Dosing to achieve rapid onset of efficacy and proactively managing infusion site pain enhance the likelihood for a patient with PAH to maintain and derive benefit from SC treprostinil therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / administration & dosage*
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use*
  • Biological Availability
  • Dose-Response Relationship, Drug
  • Epoprostenol / administration & dosage
  • Epoprostenol / adverse effects
  • Epoprostenol / analogs & derivatives*
  • Epoprostenol / therapeutic use
  • Humans
  • Hypertension, Pulmonary / drug therapy*
  • Infusions, Subcutaneous / adverse effects
  • Pain / etiology
  • Pain / prevention & control

Substances

  • Antihypertensive Agents
  • Epoprostenol
  • treprostinil