Treprostinil

How it works

It is a potent agonist at prostacyclin receptors, causing direct vasodilatation of the pulmonary and systemic arterial vascular beds and inhibition of platelet aggregation.

Prescribing in practice

• Abrupt interruption or sudden withdrawal of continuous infusion can precipitate rebound pulmonary hypertension and clinical deterioration, so treatment must not be stopped suddenly.
• It should be initiated and supervised by specialist pulmonary hypertension centres familiar with parenteral prostanoid therapy.
• Co-administration with antihypertensives, other vasodilators or anticoagulants increases the risk of hypotension and bleeding respectively.

Monitoring

Monitor blood pressure, symptoms, exercise capacity and infusion-site reactions, along with signs of bleeding given the antiplatelet effect.

Counselling the patient

• Do not stop the infusion abruptly; contact your specialist team immediately if delivery is interrupted.
• Infusion-site pain and skin reactions are common with the subcutaneous route and usually settle.
• Report headache, flushing, jaw pain, diarrhoea or symptoms of worsening breathlessness.

Evidence & guidelines

NICE and specialist pulmonary hypertension guidance support prostanoid therapy such as treprostinil for selected patients with pulmonary arterial hypertension.