Anticoagulants- because treprostinil inhibits platelet aggregation there is a potential for inceased risk of bleeding, especially amongst patients maintained on anticoagulants Antihypertensive agents, diuretics or vasodilators- reduction in blood pressure caused by treprostinil may be exacerbated by drugs that by thmeselves alter blood presssure. such a hypertensive agents, diuretics or vasodilators

Pulmonary arterial hypertension ( PAH )

CNS- dizziness ( 9%), headache (27%)

Dermatologic - pruritus (8% ), rash (14%),

GI - diarrhea (25%), nausea (22%), Miscellaneous- edema (9%) , hypotension (4%), infusion site pain (85%), infusion site reaction (83% ) jaw pain (13%), vasodilation (11%)

Known hypersensitivity to the drug

Warnings/precautions-

Administration- Route- indicated for subcutaneous or IV use only Troprostinil should be used by clinician experienced in the diagnosis and treatment of PAH Renal and hepatic function impairment- use caution in patients with hepatic or renal function impairment

Pulmonary arterial hypertension (PAH ) -

Dosage-

Initial dose- Treprostinil can be administerd by continous infusion, preferably infused subcutaneously but can be administered by central IV line if subcutaneous rout is not tolerated he infusion rate is 1.25ng/kg/min. the rate can be reduced to 0.625ng/kg/mim in required

Therapy with treprostinil will be needed for prolonged periods, possibly years.

Carefully consider the patients ability to accept and care for catheter and to use an infusion pump.

Pharmacology-

Major pharmacologic actions of terprostinil are direct vasodilation of pulmonary and systemic arterial vascular beds and inhibition of platelet aggregation

Pharmacokinetics-

Treprostinil is rapidly and completely absorbed after simultaneous infusion with an absolute bioavailability approximately 100% . Steady state concentration occured in approximately 10 hours Treprostinil is substantially metabolized by the liver. The elimination is biphasic with a terminal half life of appox. 4 hours

Pregnancy- Use treprostinil during pregnancy only if clearly needed.

Lactation- Excercise caution when treprostenil is administered to a beast feeding woman.

Children- safety and efficacy in children haved not been established

Elderly- use caution in dose selection, reflecting the greater frequency of decreased hepatic, renal or cardiac function and of concomittant disease or other drug therapy