Transition of Intravenous Treprostinil to Oral Therapy in a Patient with Functional Class IV Chronic Thromboembolic Pulmonary Hypertension

Pharmacotherapy
Kristina M ThurberRobert P Frantz

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) occurs when pulmonary emboli fail to resolve with anticoagulation. For patients with inoperable or residual CTEPH, riociguat is currently the only therapy approved by the United States Food and Drug Administration. However, some patients with CTEPH may require therapy beyond riociguat, such as intravenous prostacyclins, which can present significant administration challenges in patients with complex comorbid conditions. We describe a 42-year-old man with T12 paraplegia complicated by CTEPH (functional class IV with substantial right ventricular dysfunction) and severe pressure ulcers. In order to facilitate goals of care (hospital discharge to a skilled nursing facility where parenteral prostanoids could not be administered), he underwent rapid transition from intravenous treprostinil to oral selexipag in the form of a cross-taper over 6 days. The patient required readmission due to worsening symptoms and was transitioned back to intravenous treprostinil; he tolerated conversion to oral treprostinil for approximately 4 months, but it was subsequently discontinued due to nausea and modified goals of care. The patient underwent transition to hospice care 3 months later and eve...Continue Reading

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Citations

Oct 12, 2018·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Sherif M Fanous, Munir Janmohamed
Jun 5, 2020·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Amber Lanae MartirosovRana Awdish
May 20, 2020·Cardiovascular Drugs and Therapy·Benjamin HohlfelderSeth R Bauer
Apr 17, 2020·Frontiers in Medicine·Irene Z PanJohn J Ryan
May 3, 2019·Heart Failure Reviews·Yi ZhangZhihong Liu
Oct 2, 2020·Pediatric Pulmonology·Charissa W Kam, Fadel E Ruiz
Jan 15, 2020·Journal of Cardiovascular Pharmacology·Kishan S ParikhSudarshan Rajagopal

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