Treprostinil Sodium(tra pros’ tin ill)
Remodulin, Tyvaso
PREGNANCY CATEGORY B
Drug Classes
Endothelin receptor antagonist
Prostacyclin analogue (vasodilating drug)
Therapeutic Actions
Specifically blocks receptor sites for endothelin (ETA and ETB) in the endothelium and vascular smooth muscles; these endothelins are elevated in plasma and lung tissue of patients with pulmonary arterial hypertension; also inhibits platelet aggregation.
Indications
Treatment of pulmonary arterial hypertension in patients with NYNA class II–class IV symptoms, to improve exercise ability and to decrease the rate of clinical worsening
To diminish the rate of deterioration in patients undergoing transition from epoprostenol (Flolan)
Contraindications and Cautions
Contraindicated with allergy to treprostinil or any component of the drug.
Use cautiously in elderly patients and with hepatic or renal impairment, lactation, pregnancy.
Available Forms
Multi-use vials—1, 2.5, 5, 10 mg/mL; solution for inhalation—0.6 mg/mL
Dosages
Adults
Administered by continuous subcutaneous or IV infusion. Subcutaneous route is preferred. Use IV route only in situations in which subcutaneous route is not tolerated because of severe site reactions or pain. Initially the rate is 1.25 nanograms/kg/min. If this initial dose cannot be tolerated, the infusion rate should be reduced to 0.625 nanograms/kg/min. Rate is increased in increments of no more than 1.25 nanograms/kg/min/wk for the first 4 wk, then by 2.5 nanograms/kg/min/wk. Do not exceed 40 nanograms/kg/min. Dosage is based on clinical response and patient tolerance. Abrupt withdrawal or significant decrease in dosage may result in worsening symptoms. See the manufacturer’s instructions for infusion weight charts.
Transition from Flolan: Base rate of change on individual patient response. Start Remodulin infusion at 10% of starting Flolan dose. Decrease Flolan to 80% starting dose and increase
Remodulin dose to 30% starting Flolan dose. Decrease Flolan dose to 60% starting and increase Remodulin dose to 50% starting Flolan dose. Decrease Flolan dose to 40% starting dose and increase Remodulin dose to 70% starting Flolan dose. Decrease Flolan dose to 20% starting dose and increase Remodulin dose to 90% starting Flolan dose. Decrease Flolan dose to 5% starting dose and increase Remodulin dose to 110% starting Flolan dose. Discontinue Flolan and continue Remodulin dose at 110% of Flolan starting dose plus an additional 5%–10% as needed.
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