General

Pronunciation
tre-PROSS-ti-nil

Trade Name(s)

• Remodulin

Pregnancy Category
Category B

Ther. class.
vasodilators

Pharm. class.
prostacyclins

Indications

Treatment of pulmonary arterial hypertension in patients with New York Heart Association (NYHA) class II—IV symptoms

Action

• Treprostinil is a prostacyclin that produces direct vasodilation of pulmonary and systemic arterial vascular beds

• Also inhibits platelet aggregation

Therapeutic Effect(s):
Decreased exercise-associated symptoms in patients with pulmonary arterial hypertension

Pharmacokinetics

Absorption: Rapidly and completely (near 100%) absorbed following subcut administration

Distribution: Unknown

Protein Binding: 91%

Metabolism and Excretion: Extensively metabolized by the liver, metabolites are renally excreted; minimal excretion of unchanged drug in urine

Half-life: 4 hr

TIME/ACTION PROFILE (clinical improvement)

ROUTE	ONSET	PEAK	DURATION
Subcut	unknown	1 wk	unknown

Contraindication/Precautions

Contraindicated in:
Known hypersensitivity

Use Cautiously in:

• Renal impairment

• Hepatic impairment (dose reduction recommended in mild to moderate hepatic insufficiency; data not available for severe hepatic insufficiency)

• Avoid abrupt discontinuation or rapid dosage reduction

• Pregnancy (use only if clearly needed)

• Lactation or children <=16 yr

Adverse Reactions/Side Effects

CNS: dizziness, headache.

CV: vasodilation, hypotension, edema.

GI: diarrhea, nausea.

Derm: rash, pruritus, flushing.

Local: infusion site pain/reaction.

MS: jaw pain.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug

• Increased risk of hypotension with antihypertensives, diuretics, or vasodilators

• Risk of bleeding may be increased by concurrent use of anticoagulants

Route/Dosage

• SC (Adults): 1.25 ng/kg/min, may be reduced to 0.625 ng/kg/min if intolerance occurs. Increments of no more than 1.25 ng/kg/min may be made weekly for the first 4 wk and then no more than 2.5 ng/kg/min weekly for the remainder of therapy up to 40 ng/kg/min. Avoid abrupt discontinuation or rapid decrease in dosing. Infusion rate may be calculated with the following formula: Infusion rate (ml/hr) = Dose (ng/kg/min) × weight (kg) × [0.00006/treprostinil dose strength concentration (mg/ml) ].

Availability

• Solution for continuous subcut administration (no dilution required): 1 mg/ml in 20–ml vials, 2.5 mg/ml in 20–ml vials, 5 mg/ml in 20–ml vials, 10 mg/ml in 20–ml vials

Assessment

• Monitor patient for signs of improvement in pulmonary arterial hypertension (decrease in dyspnea, increased exercise tolerance) periodically throughout therapy

• Assess patient for infusion site reactions (pain, erythema, induration, rash) throughout therapy

Potential Nursing Diagnoses

• Activity intolerance (Indications)

• Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

• Treprostinil should be used only by physicians experienced in the treatment of pulmonary arterial hypertension. Initiation of therapy should be in a setting equipment and personnel for monitoring and emergency treatment

» Assess patient's ability to accept and administer treprostinil, and insert and care for infusion system prior to initiating therapy

» Dose should be increased for lack of improvement or worsening in symptoms, or decreased for excessive side effects or infusion site reactions

» Avoid abrupt withdrawal or large dose reductions; may result in worsening of symptoms of pulmonary arterial hypertension

• SC: Administer without diluting solution via a self-inserted subcut catheter and an infusion pump designed for subcut drug delivery. During use, a single syringe can be administered up to 72 hr. A single vial should be used for up to 14 days after initial introduction into vial. Do not administer solutions that are discolored or contain particulate matter. Refer to manufacturer's instructions

• Rate: See Route and Dosage section

Patient/Family Teaching

• Instruct patient on insertion of catheter and use of pump. Patient must have immediate access to a backup infusion pump and subcut infusion sets to prevent potential interruptions in drug delivery

• Inform patient that subsequent disease management may require IV therapy

• Instruct patient to inform health care professional if headache, nausea, vomiting, restlessness, anxiety, or infusion site reactions occur

• Inform patient and family that therapy may be required for years to control disease

Evaluation/Desired Outcomes

Improved exercise tolerance in patients with pulmonary arterial hypertension

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