Treprostinil Sodium (tre-pros′tin-il)
Classification: PROSTAGLANDIN; PULMONARY ANTIHYPERTENSIVE; VASODILATOR
Therapeutic: PULMONARY ANTIHYPERTENSIVE
Solution for injection; solution for inhalation
ACTION & THERAPEUTIC EFFECT
Causes direct vasodilation of the pulmonary and
systemic arterial vascular beds, and inhibition of platelet aggregation. The vasodilatory
effects reduce right and left ventricular afterload, and increase cardiac
output and stroke volume. Also improves dyspnea, fatigue, and signs and
symptoms of pulmonary arterial hypertension (PAH). Vasodilation of the arteries in the pulmonary system results
in lowering of pulmonary arterial
hypertension (PAH).
Treatment of pulmonary arterial hypertension
(PAH).
Severe intermittent claudication.
Severe hepatic insufficiency; hypersensitivity to
treprostinil.
Mild or moderate hepatic insufficiency; bleeding
disorders; elderly; renal disease, renal impairment, renal failure; pregnancy (category
B), lactation. Safety and efficacy in children younger than 16 y are not
established.
Pulmonary Arterial Hypertension
Subcutaneous/ IV 1.25 ng/kg/min. If dose is not tolerated, reduce
to 0.625 ng/kg/min. Then increase rate by no
more than 1.25 ng/kg/min/ wk for first 4 wk, then by 2.5 ng/ kg/min/wk
until achieve desired response. There is little experience with
doses greater than 40 ng/ kg/min. See package insert for cross
taper schedule switching from epoprostenol to treprostenil.
Adult: Inhalation 3 breaths (18 mcg) via inhalation system 4 × day, may increase by 3 breaths at 1–2 wk
intervals.
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| Treprostinil Sodium Uses, Dosage, Side Effects |
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- Give treprostinil inhalation solution undiluted
using the Tyvaso Inhalation System. A single breath delivers approximately 6
mcg of treprostinil.
- Administer treprostinil undiluted by continuous
infusion through a subcutaneous catheter. Use an infusion pump designed for
subcutaneous delivery.
- Avoid abrupt withdrawal or sudden large
reductions in dosage as these may lead to worsening of PAH symptom.
May be given as IV infusion via a central line
when the subcutaneous route is not feasible.
PREPARE: Infusion: Dilute with sterile water for injection or NS.
- Follow specific directions for preparation
provided by the manufacturer.
ADMINISTER: Infusion: Given by continuous infusion via a central venous catheter.
Interruptions in drug delivery MUST be avoided.
- Have backup delivery system readily available.
- Store at 15°–25° C (59°–77° F).
Body as a Whole: Jaw pain, flushing, syncope. CNS:
Headache, dizziness. CV: Vasodilation, edema, hypotension. GI:
Diarrhea, nausea,
vomiting. Skin: Rash, pruritus. Other:
Infusion site reactions
(erythema, hematoma, induration, pruritus, rash, injection site pain).
Drug: NSAIDS, ANTICOAGULANTS may increase risk of bleeding; ANTIHYPERTENSIVE
AGENTS, DIURETICS, VASODILATORS may exacerbate hypotension; ephedrine, pseudoephedrine
may antagonize antihypertensive effects. Herbal: Ephedra, ma huang may antagonize antihypertensive effects.
Absorption: Completely absorbed from subcutaneous
site. Onset: Steady state
reached in 10 h. Metabolism: Extensively in liver by unknown enzyme system. Elimination:
79% in urine, 13% in feces. Half-Life: 2–4 h.
Assessment & Drug Effects
- Monitor for therapeutic effectiveness indicated
by less dyspnea and fatigue, increased activity tolerance, and improved
hemodynamic parameters.
- Monitor for and report symptoms of excessive
response to the drug including: Headache, nausea, emesis, restlessness, anxiety
and infusion site pain or reaction (e.g., erythema, induration or rash). If these
occur, the rate of subcutaneous infusion should be slowed.
- Monitor BP closely, especially if taking
concurrent antihypertensive drugs (e.g., diuretics, vasodilators).
- Monitor lab tests: Baseline and periodic LFTs
and renal function tests. Periodic coagulation parameters (more often if on
concurrent anticoagulation therapy).
Patient & Family Education
- Note: Therapy with this drug may be needed for
prolonged periods, possibly years.
- Report any of the following: Headache, nausea,
vomiting, restlessness, anxiety, and infusion site pain.
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