Direct and rapid transition from IV epoprostenol to oral treprostinil was successfully achieved in 72 hours without reported adverse effects in a patient with pulmonary arterial hypertension.
Case Report (n=1)
Can a patient with pulmonary arterial hypertension be safely and directly transitioned from IV epoprostenol to oral treprostinil?
Direct and rapid conversion from IV epoprostenol to oral treprostinil over 72 hours was safely achieved in a patient with PAH.
PURPOSE: Epoprostenol and treprostinil are prostacyclins indicated for the treatment of pulmonary arterial hypertension (PAH). Although there is literature describing the conversion of intravenous (IV) epoprostenol to IV treprostinil or IV treprostinil to oral treprostinil, there is little data on the direct conversion of IV epoprostenol to oral treprostinil. In this case, we describe the direct conversion of IV epoprostenol to oral treprostinil without an intermediary conversion to IV treprostinil. SUMMARY: A 39 year-old female with PAH was admitted for altered mental status and self-removal of her peripherally inserted central catheter (PICC) used for IV epoprostenol. Given the unplanned hospitalization, absence of a dedicated central line for IV prostacyclin therapy, and concern the patient may remove a future subcutaneous line, the patient was transitioned to oral treprostinil. Of note, despite triple PAH therapy, the patient was unable to reach a low risk group based on her prognostic risk assessment. A right heart catheterization four months prior found severe PAH with a pulmonary arterial pressure of 79/32 mmHg (mean, 49 mmHg) and pulmonary vascular resistance of 10.6 Wood units. To expedite the transition, the patient was directly converted from IV epoprostenol to oral treprostinil without an intermediary conversion to IV treprostinil. A target oral treprostinil dose of 5 mg TID was calculated based on 110% of the IV epoprostenol dose (19 ng/kg/min) utilizing the conversion recommended by the medication manufacturer. Every 8 hours, IV epoprostenol was decreased by 2 ng/kg/min and oral treprostinil was increased by 0.5 mg. The target oral treprostinil dose of 5 mg TID was reached 72 hours after conversion initiation. Three hours after the final titration, the patient was discharged home on room air. CONCLUSION: In this case, rapid transition from IV epoprostenol to oral treprostinil was achieved in 72 hours without reported adverse effects.
Sarangarm et al. (Tue,) conducted a case report in Group 1 pulmonary arterial hypertension (n=1). Direct conversion to oral treprostinil was evaluated on Successful transition and adverse effects. Direct and rapid transition from IV epoprostenol to oral treprostinil was successfully achieved in 72 hours without reported adverse effects in a patient with pulmonary arterial hypertension.