Inhaled treprostinil sodium for pulmonary hypertension

Introduction: Pulmonary arterial hypertension is an increasingly recognized heterogeneous disease with significant morbidity and mortality, requiring a multimodal approach to treatment. Inhalation administration of treprostinil sodium (Tyvaso®) permits higher local drug concentration without some of the side effects of parenteral prostanoids. Areas covered: After a broad discussion centering on available prostacyclins, a thorough literature review of treprostinil is undertaken, focusing on the timeline of clinical studies, specifically highlighting the major trials that shape current indications and usage. The literature search was undertaken via multiple search engines and strategies with review of cited and associated articles to provide a comprehensive discussion on the topic. Expert opinion: While safe and well tolerated, inhaled treprostinil sodium should be limited, based on available data, to use as add-on therapy for patients with Group I pulmonary hypertension not effectively controlled on oral therapy. Despite documented safety for the conversion from inhaled iloprost to inhaled treprostinil, the transition of patients stable on parenteral agents to inhaled treprostinil should be cautioned due to the potential for clinical decompensation.