title: Staggered transition to epoprostenol from treprostinil in pulmonary arterial hypertension.
abstract: OBJECTIVE
  To describe a successful transition process from subcutaneous treprostinil to intravenous epoprostenol after the failure of treprostinil in a patient with idiopathic pulmonary arterial hypertension and present an algorithm to achieve the conversion without significant adverse reactions.
  
  
  METHODS
  A 25-year-old white female receiving subcutaneous treprostinil 97 ng/kg/min was admitted to the intensive care unit for transition from subcutaneous treprostinil to a target intravenous epoprostenol dose of 72 ng/kg/min via a staggered interval dose adjustment approach. The patient experienced facial flushing, hot flashes, and headache when dose adjustments of the drugs were made simultaneously; however, when dose adjustments were staggered, the adverse reactions did not occur and larger adjustments could be achieved.
  
  
  CONCLUSIONS
  This case demonstrates a suboptimal therapeutic response to treprostinil for the treatment of idiopathic pulmonary arterial hypertension. The transition of treprostinil to epoprostenol is rare; however, in the event therapy change is needed, dosing information is minimal. A staggered transition dosing regimen that accounts for the pharmacokinetic differences between epoprostenol and treprostinil was successfully used in this case.
  
  
  CONCLUSIONS
  The approach in this case demonstrates the success of staggered-interval dose adjustments to minimize supratherapeutic symptoms and coincides with the pharmacokinetic profile of the 2 medications.
authors.affiliation: University of Nebraska Medical Center, Omaha, NE 68198-6045, USA.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Reisbig
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Coffman
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Floreani
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Bultsma
authors.forename: Keith M
authors.initials: KM
authors.lastname: Olsen
mesh_terms: D000328:Adult; D011464:Epoprostenol / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006261:Headache / Q000139:chemically induced; D019584:Hot Flashes / Q000139:chemically induced; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D011651:Pulmonary Artery / Q000187:drug effects / Q000502:physiology
chemical_list: D011464:Epoprostenol; C427248:treprostinil