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Editorials |

Transition From IV to Subcutaneous Prostacyclin : Premature Withdrawal?

Shelley Shapiro, MD, PhD; Nicholas S. Hill, MD, FCCP
Author and Funding Information

Affiliations: Los Angeles, CA ,  Boston, MA ,  Dr. Shapiro is Clinical Professor of Medicine, David Geffen School of Medicine at UCLA, Department of Veterans Affairs, Greater Los Angeles Healthcare System; and Dr. Hill is from the Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, Boston, MA.

Correspondence to: Shelley Shapiro, MD, PhD, David Geffen UCLA School of Medicine, Greater Los Angeles VA Medical Center, 11301 Wilshire Blvd, Cardiology Section 111e, Los Angeles, CA 90073; e-mail: Shelley.Shapiro@va.gov



Chest. 2007;132(3):741-743. doi:10.1378/chest.07-1992
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“Once on Flolan, forever on Flolan” was what patients starting IV epoprostenol (Flolan; GlaxoSmithKline; Middlesex, UK) were once told. Prior to 2001, it was the only approved pulmonary hypertension therapy; because of its short half-life, a catheter break, pump malfunction, or abrupt discontinuation could result in severe withdrawal symptoms or death. Thus, epoprostenol was perceived as a life-long commitment. In 2001, the approval of oral bosentan and subcutaneous treprostinil gave patients the hope that “once on Flolan” might not mean “forever on Flolan.” Preliminary reports13 began to emerge describing results of transitions to them from IV epoprostenol. The study by Rubenfire et al4 in the current issue of CHEST (see page 757) is the first randomized, placebo-controlled trial of such a transition of stable patients to subcutaneous treprostinil.

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