Staggered transition to epoprostenol from treprostinil in pulmonary arterial hypertension

Katharine A. Reisbig, Pamela A. Coffman, Anthony A. Floreani, Christopher J. Bultsma, Keith M. Olsen

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


OBJECTIVE: To describe a successful transition process from subcutaneous treprostinil to intravenous epoprostenol after the failure of treprostinil in a patient with idiopathic pulmonary arterial hypertension and present an algorithm to achieve the conversion without significant adverse reactions. CASE SUMMARY: A 25-year-old white female receiving subcutaneous treprostinil 97 ng/kg/min was admitted to the intensive care unit for transition from subcutaneous treprostinil to a target intravenous epoprostenol dose of 72 ng/kg/min via a staggered interval dose adjustment approach. The patient experienced facial flushing, hot flashes, and headache when dose adjustments of the drugs were made simultaneously; however, when dose adjustments were staggered, the adverse reactions did not occur and larger adjustments could be achieved. DISCUSSION: This case demonstrates a suboptimal therapeutic response to treprostinil for the treatment of idiopathic pulmonary arterial hypertension. The transition of treprostinil to epoprostenol is rare; however, in the event therapy change is needed, dosing information is minimal. A staggered transition dosing regimen that accounts for the pharmacokinetic differences between epoprostenol and treprostinil was successfully used in this case. CONCLUSIONS: The approach in this case demonstrates the success of staggered-interval dose adjustments to minimize supra-therapeutic symptoms and coincides with the pharmacokinetic profile of the 2 medications.

Original languageEnglish (US)
Pages (from-to)739-743
Number of pages5
JournalAnnals of Pharmacotherapy
Issue number4
StatePublished - Apr 2005


  • Epoprostenol
  • Prostacyclin
  • Pulmonary arterial hypertension
  • Treprostinil

ASJC Scopus subject areas

  • Pharmacology (medical)

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