Pulmonary Vascular Disease |

One Center Approach to Transitioning IV Treprostinil to IV Epoprostenol: A Case Study FREE TO VIEW

Carolyn Pugliese, MSN; Raylene Matlock, BSN; Ross Davies, MD; Lisa Mielniczuk, MD; George Chandy, MD; Duncan Stewart, MD; Vladimir Contreras-Dominguez, MD
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The University of Ottawa Heart Institute, Ottawa, ON, Canada

Chest. 2014;145(3_MeetingAbstracts):502A. doi:10.1378/chest.1821811
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SESSION TITLE: Pulmonary Vascular Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: This patient diagnosed in 2005 with Idiopathic Pulmonary Arterial Hypertension was successfully treated with an ERA for 6 years. In October 2011, functional capacity decreased to IV and the patient was started on IV treprostinil by patient’s choice. We achieved a dose of 50 ng-kg-min and patient returned to functional class II. Over time the dose was decreased to 34 ng-kg-min due to intolerable side effects resulting in functional III symptoms and worsening hemodynamics. The patient was given the option to transition to IV epoprostenol which we did on August 7, 2013.

CASE PRESENTATION: A Literature review was completed finding no reports describing the transition from IV treprostinil to IV epoprostenol. Articles were found transitioning from SQ treprostinil to IV epoprostonol. The training was done as an outpatient in the patient’s home by a Specialty RN from the Patient Assistance Program. The Patient was subsequently admitted to hospital for the transition to eopprostonol. IV treprostinil at 38 ng-kg-min was stopped and withdrawn out of Hickman® catheter. The catheter was then flushed with normal saline. After 1.5 hours, IV epoprostenol was started at 12 ng-kg-min. Continuous heart rate and blood pressure monitoring were done every 15 minutes until the following morning.

DISCUSSION: Patient was re-assessed next morning and found to be stable with slight jaw pain eating breakfast and felt that she may be a bit more short of breath. Consequently the team decided to increase dose to 14 ng-kg-min and prepare for discharge. This presentation will discuss our protocol used for successful transition from IV treprostinil to IV epoprostenol.

CONCLUSIONS: This case report describes a successful transition from IV treprostinil to IV epoprostenol by stopping treprostinil and starting epoprostenol after a delay based on half life of the therapies.

Reference #1: Reisbig, K.A, et. al. 2005. Staggered Transition to Epoprostenol from Treprostinil in Pulmonary Arterial Hypertension. The Annals of Pharmacotherapy. 39, 739-43.

Reference #2: Vachiéry J, et. al. 2002. Transitioning From IV Epoprostenol to Subcutaneous Treprostinil in Pulmonary Artery Hypertension. Chest. 121, 1561-5.

DISCLOSURE: The following authors have nothing to disclose: Carolyn Pugliese, Raylene Matlock, Ross Davies, Lisa Mielniczuk, George Chandy, Duncan Stewart, Vladimir Contreras-Dominguez

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