Impact of four times daily dosing of oral treprostinil on tolerability and daily dose achieved in pulmonary hypertension. (November 2017)

• Record Type: Journal Article
• Authors: Coons, James C.; Bunner, Cheryl; Ishizawar, David C.; Risbano, Michael G.; Rivera-Lebron, Belinda; Mathier, Michael A.; Chan, Stephen Y.; Simon, Marc A.
• Is Part Of: Pulmonary circulation. Volume 8:Number 1(2018)
• Publication Date: 2017-11
• Subjects: prostacyclin -- dosing -- pulmonary arterial hypertension; Pulmonary circulation -- Periodicals; Pulmonary circulation; Electronic journals -- Sciences; Periodicals; 616.24005
• DOI: 10.1177/2045893217744512
• Languages: English
• ISSNs: 2045-8932

Abstract

Oral treprostinil (TRE) is a prostacylin that is approved for the treatment of patients with pulmonary arterial hypertension (PAH). Dosing is approved for two or three times daily (t.i.d.); however, adverse effects, including gastrointestinal-related symptoms, may limit the ability to reach optimal doses. We report our experience with a four times daily (q.i.d.) regimen of oral TRE for goal-directed therapy of PAH. We describe three patients that were transitioned from infusion or inhaled TRE to oral TRE with initial t.i.d. dosing over a four-day hospital stay. All patients were subsequently further dose-adjusted in the outpatient setting; however, adverse effects limited additional up-titration despite persistent dyspnea. In a carefully monitored outpatient setting, patients were switched from t.i.d. to q.i.d. dosing of oral TRE. All three patients were successfully dosed q.i.d., having achieved a higher total daily dose compared with a t.i.d. dose regimen. Furthermore, patients were able to maintain functional class II symptoms with mitigation of adverse effects using the q.i.d. dose regimen.