Adult Dosing
Pulmonary arterial hypertension
- Start 1.25 ng/kg/min SC/IV, reduce to 0.625 ng/kg/min if initial dose not tolerated
- Increase 1.25 ng/kg/min every week x 4 wks, then 2.5 ng/kg/min every week to establish a dose at which PAH symptoms are improved
- Max: 40 ng/kg/min
- For transitioning patients from epoprostenol, start treprostinil at 10% of epoprostenol dose. Titer slowly while reducing epoprostenol dose
Notes:- SC route preferred
- Use permanent central line for IV
- For IV infusion dilute in sterile water for injection, 0.9% sodium chloride injection
- Calculate subcutaneous infusion rate using the following formula: subcutaneous infusion rate (mL/h) = (dose [ng/kg/min] × weight [kg] × 0.00006)/treprostinil vial strength (mg/mL)
- Conversion factor of 0.00006 = 60 min/hour × 0.000001 mg/ng
Pediatric Dosing
- Safety and effectiveness in pediatric patient have not been established
- Subcutaneous infusion is the preferred mode of administration for treprostinil as chronic intravenous infusion delivered using indwelling central venous catheter is associated with the risk of blood stream infections and sepsis, which may be fatal
- Treprostinil should be used only by clinicians experienced in the diagnosis and treatment of PAH and in a setting with adequate personnel and equipment for physiological monitoring and emergency care
- Reserve continuous infusion for patients intolerant to SC route
- Increased risk of bleeding due to platelet aggregation inhibition
- Increased risk of symptomatic hypotension in patients with low systemic arterial pressure or receiving blood pressure lowering agents
- Avoid abrupt discontinuation or rapid dosage reduction, as it causes rebound pulmonary hypertension
- Increase the dose for lack of improvement in, or worsening of, symptoms and decrease for excessive pharmacologic effects or for unacceptable infusion site symptoms
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
Pregnancy Category:B
Breastfeeding: Safety unknown. Excretion of treprostinil in human milk or systemic absorption after ingestion is unknown, however manufacturer advises to use cautiously while administering nursing mother as many drugs are excreted in milk.
