Impact of four times daily dosing of oral treprostinil on tolerability and daily dose achieved in pulmonary hypertension

• Published in: Pulmonary circulation 2018-01, Vol.8 (1), p.1-4
• Main Authors: Coons, James C., Bunner, Cheryl, Ishizawar, David C., Risbano, Michael G., Rivera-Lebron, Belinda, Mathier, Michael A., Chan, Stephen Y., Simon, Marc A.
• Format: Article
• Language: English
• Subjects: Case Report; dosing; prostacyclin; pulmonary arterial hypertension; Pulmonary hypertension
• ISSN: 2045-8940; 2045-8932; 2045-8940
• DOI: 10.1177/2045893217744512

Oral treprostinil (TRE) is a prostacylin that is approved for the treatment of patients with pulmonary arterial hypertension (PAH). Dosing is approved for two or three times daily (t.i.d.); however, adverse effects, including gastrointestinal-related symptoms, may limit the ability to reach optimal doses. We report our experience with a four times daily (q.i.d.) regimen of oral TRE for goal-directed therapy of PAH. We describe three patients that were transitioned from infusion or inhaled TRE to oral TRE with initial t.i.d. dosing over a four-day hospital stay. All patients were subsequently further dose-adjusted in the outpatient setting; however, adverse effects limited additional up-titration despite persistent dyspnea. In a carefully monitored outpatient setting, patients were switched from t.i.d. to q.i.d. dosing of oral TRE. All three patients were successfully dosed q.i.d., having achieved a higher total daily dose compared with a t.i.d. dose regimen. Furthermore, patients were able to maintain functional class II symptoms with mitigation of adverse effects using the q.i.d. dose regimen.