Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece.
Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece.
Int J Cardiol. 2020 May 1;306:187-189. doi: 10.1016/j.ijcard.2020.02.050. Epub 2020 Feb 19.
Despite advantages in the treatment options of pulmonary arterial hypertension, continuous parenteral prostanoid administration, although often complicated by serious side effects, remains the treatment of choice for patients with advanced disease. The need of transitioning from one parenteral prostanoid agent to the other is often faced in the daily clinical practise. Up to today, there is no established transition protocol from subcutaneous treprostinil to intravenous epoprostenol.
A staggered approach to subcutaneous treprostinil down-titration with simultaneous epoprostenol up-titration is described. Subcutaneous treprostinil is down-titrated by 5 ng/kg/min every 5 h while intravenous epoprostenol is up-titrated by 2 ng/kg/min every 2 h.
The designed protocol was implemented in 4 patients with pulmonary arterial hypertension (3 women, median age 70.5 (range 38-79) years). Median starting subcutaneous treprostinil dose was 44.5 (range 37-100) ng/kg/min and median treprostinil down-titration time was 32.5 (range 25-85) hours. The median maximal epoprostenol dose was 36 (range 28-90) ng/kg/min, achieved in 36 (range 30-90) hours. Only mild prostanoid-related side effects were reported.
The proposed staggered transition protocol from subcutaneous treprostinil to intravenous epoprostenol was safe in a limited number of patients with pulmonary arterial hypertension.
尽管肺动脉高压的治疗选择有优势，但连续给予前列腺素类药物虽然常伴有严重副作用，但仍是晚期疾病患者的治疗选择。在日常临床实践中，经常需要从一种前列腺素类药物转换为另一种。迄今为止，尚无从皮下曲前列尼尔转换为静脉依前列醇的既定转换方案。
描述了一种从皮下曲前列尼尔逐渐减量与同时静脉依前列醇逐渐增量的交错方法。皮下曲前列尼尔每 5 小时减少 5ng/kg/min，同时静脉依前列醇每 2 小时增加 2ng/kg/min。
该方案在 4 例肺动脉高压患者（3 名女性，中位年龄 70.5（范围 38-79）岁）中实施。中位起始皮下曲前列尼尔剂量为 44.5（范围 37-100）ng/kg/min，曲前列尼尔逐渐减量时间为 32.5（范围 25-85）小时。中位最大依前列醇剂量为 36（范围 28-90）ng/kg/min，在 36（范围 30-90）小时内达到。仅报告了轻微的前列腺素相关副作用。
在有限数量的肺动脉高压患者中，皮下曲前列尼尔到静脉依前列醇的这种交错转换方案是安全的。
