title: Transitioning from parenteral treprostinil to inhaled treprostinil in patients with pulmonary arterial hypertension.
abstract: Treprostinil is a potent prostacyclin vasodilator indicated for the treatment of pulmonary arterial hypertension (PAH, World Health Organization Group I). Previously, treprostinil was available only in subcutaneous (SC) or intravenous (IV) formulations. Availability of an inhaled formulation of treprostinil has provided clinicians with an alternative to continuous SC or IV treprostinil in appropriate patients. Stable PAH patients whose quality of life has been dramatically impacted by side effects of parenteral therapy or those who have had recurrent, life-threatening bloodstream infections but are otherwise responding well to treatment may be the candidates for continuing prostacyclin therapy with inhaled treprostinil. However, there is little clinical experience with transitioning patients from parenteral to inhaled treprostinil. We present the results of two cases that highlight important considerations in transitioning patients from parenteral to inhaled therapy, including the pharmacologic and clinical equivalence of formulations, dose titration of formulations and suggested criteria for patient selection.
authors: Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA.
authors: Amresh
authors: A
authors: Raina
authors: James C
authors: JC
authors: Coons
authors: Manreet
authors: M
authors: Kanwar
authors: Srinivas
authors: S
authors: Murali
authors: George
authors: G
authors: Sokos
authors: Raymond L
authors: RL
authors: Benza
keywords: case study; prostacyclin; prostanoid; pulmonary arterial hypertension; transition; treprostinil
references: Am J Respir Crit Care Med. 2002 Mar 15;165(6):800-4
references: 11897647
references: N Engl J Med. 2004 Oct 14;351(16):1655-65
references: 15483284
references: N Engl J Med. 1996 Feb 1;334(5):296-301
references: 8532025
references: J Am Coll Cardiol. 2006 Oct 17;48(8):1672-81
references: 17045906
references: Chest. 2006 Nov;130(5):1471-80
references: 17099026
references: Am J Cardiol. 2012 Nov 15;110(10):1546-50
references: 22853986
references: J Clin Pharmacol. 2004 May;44(5):503-9
references: 15102871
references: J Clin Pharmacol. 2004 Jan;44(1):83-8
references: 14681345
references: Circulation. 2009 Apr 28;119(16):2250-94
references: 19332472
references: Infect Control Hosp Epidemiol. 2008 Apr;29(4):342-9
references: 18462147
references: Chest. 2012 Feb;141(2):354-362
references: 21680644
references: Eur Respir J. 2006 Dec;28(6):1195-203
references: 16899485
references: J Am Coll Cardiol. 2010 May 4;55(18):1915-22
references: 20430262
references: Chest. 2006 Mar;129(3):683-8
references: 16537868
references: J Cardiovasc Pharmacol. 2004 Aug;44(2):209-14
references: 15243302
references: J Clin Pharmacol. 2008 Jan;48(1):19-25
references: 18094217
references: J Heart Lung Transplant. 2010 Feb;29(2):137-49
references: 20022264
references: Chest. 2006 Jun;129(6):1636-43
references: 16778286