Treprostinil

How it works

As a stable analogue of prostacyclin, it stimulates prostacyclin receptors to cause pulmonary and systemic vasodilatation and inhibit platelet aggregation, reducing pulmonary vascular resistance.

Prescribing in practice

• Abrupt interruption of a continuous infusion can cause rebound worsening of pulmonary hypertension, so therapy must not be stopped suddenly and infusion continuity safeguarded.
• Its vasodilator and antiplatelet effects raise the risk of hypotension and bleeding, requiring care with anticoagulants, antihypertensives and other vasodilators.
• Subcutaneous infusion-site pain and reaction are very common and a frequent reason for difficulty tolerating treatment.

Monitoring

Monitor blood pressure, functional capacity and symptoms of pulmonary hypertension, alongside infusion-site tolerability and signs of bleeding, under specialist supervision.

Counselling the patient

• Never stop the infusion abruptly and contact the specialist team urgently if delivery is interrupted.
• Headache, flushing, jaw pain and infusion-site discomfort are common, especially early on.

Evidence & guidelines

Treprostinil is supported by randomised trials in pulmonary arterial hypertension showing improved exercise capacity, underpinning its specialist use in current pulmonary hypertension guidance.