title: Case report: a patient with pulmonary arterial hypertension transitioning from a PDE-5 inhibitor to Riociguat.
abstract: We present here the case of a patient with pulmonary arterial hypertension and NYHA Class II symptoms who transitioned from PDE-5i therapy to riociguat. No protocol currently exists for transitioning between these PAH medications.
  
  
  
  A 59-year old male with a history of anorexigen use initially presented in 2008 and was felt to have non-operable small vessel disease. His care was transitioned to our center after insurance would not cover high-dose sildenafil in addition to ERA therapy.
  
  
  
  This case demonstrates a safe and successful transition from higher dose PDE-5is to riociguat with no interruption in therapy.
authors.affiliation: Division of Pulmonary, Critical Care, & Sleep Medicine, University of California, San Diego, CA, USA. dspoch@ucsd.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Poch
mesh_terms: D065627:Familial Primary Pulmonary Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D011720:Pyrazoles / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D000068677:Sildenafil Citrate / Q000627:therapeutic use*; D000069341:Transitional Care
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D011720:Pyrazoles; D011743:Pyrimidines; D000068677:Sildenafil Citrate; C542595:riociguat
keywords: Chronic thromboembolic pulmonary hypertension; Cyclic guanosine monophosphate; Pulmonary arterial hypertension; sGC stimulators