Neuropsychiatric reaction to treprostinil in pulmonary hypertension leading to treatment discontinuation

A patient presented with dyspnoea and was subsequently diagnosed with pulmonary hypertension. Intravenous treprostinil was initiated as part of the treatment plan. Shortly after starting therapy, the patient developed new-onset restlessness and agitation, which progressively worsened in correlation with dose escalation. There were no clinical, metabolic, neuropsychiatric or pharmacologic factors identified to account for the patient's agitation, and no evidence of substance withdrawal or other medication changes apart from treprostinil initiation. The symptoms became increasingly disruptive, prompting discontinuation of treprostinil. The patient's condition improved rapidly after the drug was stopped, raising concern for a possible neuropsychiatric adverse reaction. While treprostinil is known to cause common side effects such as headache, jaw pain and flushing, behavioural disturbances are not widely recognised. This case suggests a potential reversible neuropsychiatric effect of treprostinil and emphasises the importance of monitoring for atypical side effects, particularly in patients who develop unexplained agitation during therapy.