%0 Journal Article
%T Impact of four times daily dosing of oral treprostinil on tolerability and daily dose achieved in pulmonary hypertension
%A Belinda Rivera-Lebron
%A Cheryl Bunner
%A David C. Ishizawar
%A James C. Coons
%A Marc A. Simon
%A Michael A. Mathier
%A Michael G. Risbano
%A Stephen Y. Chan
%J Pulmonary Circulation
%@ 2045-8940
%D 2018
%R 10.1177/2045893217744512
%X Oral treprostinil (TRE) is a prostacylin that is approved for the treatment of patients with pulmonary arterial hypertension (PAH). Dosing is approved for two or three times daily (t.i.d.); however, adverse effects, including gastrointestinal-related symptoms, may limit the ability to reach optimal doses. We report our experience with a four times daily (q.i.d.) regimen of oral TRE for goal-directed therapy of PAH. We describe three patients that were transitioned from infusion or inhaled TRE to oral TRE with initial t.i.d. dosing over a four-day hospital stay. All patients were subsequently further dose-adjusted in the outpatient setting; however, adverse effects limited additional up-titration despite persistent dyspnea. In a carefully monitored outpatient setting, patients were switched from t.i.d. to q.i.d. dosing of oral TRE. All three patients were successfully dosed q.i.d., having achieved a higher total daily dose compared with a t.i.d. dose regimen. Furthermore, patients were able to maintain functional class II symptoms with mitigation of adverse effects using the q.i.d. dose regimen
%K prostacyclin
%K dosing
%K pulmonary arterial hypertension
%U https://journals.sagepub.com/doi/full/10.1177/2045893217744512