Transitioning From Oral to Intravenous Treprostinil in Pulmonary Arterial Hypertension: A Case Report

The optimal approach to transitioning from oral treprostinil to intravenous treprostinil in pulmonary arterial hypertension (PAH) has been poorly characterized in published literature. We present a case involving a 21-year-old male with PAH experiencing worsening symptoms despite treatment with high doses of oral treprostinil (36.75 mg three times daily), ambrisentan, and tadalafil. The patient was admitted to our institution for transition from oral to intravenous treprostinil due to severe PAH as demonstrated on right heart catheterization (RHC). The transition process involved cross-tapering intravenous and oral treprostinil over 11 days with the aid of central venous pressure (CVP) measurements and noninvasive blood pressure monitoring. The patient remained clinically stable throughout the transition, and a repeat RHC upon completion demonstrated hemodynamic stability on a final dose of intravenous treprostinil 100 ng/kg/min. This case demonstrates that it is possible to safely transition from oral to intravenous treprostinil more rapidly than recommended by product labeling.