Treprostinil
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Infusion site pain: case report A 14-year-old boy developed infusion site pain at the lower abdomen during treatment with treprostinil for pulmonary artery hypertension. The boy, who had been diagnosed with pulmonary artery hypertension at the age of 5 years, was referred for further evaluation and treatment. He had received treatment with bosentan, sildenafil and continuous infusion of epoprostenol resulting in improved pulmonary artery pressure. After 2 years of treatment, epoprostenol was discontinued. One year later, he again developed elevated pulmonary artery pressure. Further examination revealed a congenital extrahepatic porto-systemic shunt. At 9 years of age, he underwent ligation of shunt vessels. However, his pulmonary artery pressure did not decrease and epoprostenol was reinitiated via a central venous line because of mild atopic dermatitis prior to the initial procedure. After one year, the central venous line became infected frequently due to atopic dermatitis. His bosentan and sildenafil doses were increased and then changed. Subsequently, his epoprostenol was also switched to SC treprostinil infusion 2.5 mg/mL at a rate of 2.2 mL/hours given at the lower abdominal site. However, he experienced severe infusion site pain. The boy started receiving oral analgesic treatment with naproxen and paracetamol [acetaminophen] at maximum doses, but his pain did not resolve. He stayed home from school due to the pain. It was observed that his pain became worse with increased treprostinil infusion rate. Therefore, his treprostinil concentration increased to 5 mg/mL with reduced infusion rate to 1.1 mL/hour. However, his infusion site pain still persisted despite 6 months of oral analgesic treatment. Therefore, palliative care specialist suggested a change in treprostinil infusion site to the upper buttocks as more abundant fat is available there. After changing the infusion site to the right upper buttock, his pain significantly improved. Thereafter, the doses of analgesics were decreased, and he was able to go to school. He did not experienced problems while sitting, but slept sideways with the infusion site up. Ono H, et al. Using the upper buttocks as a subcutaneous site for treprostinil infusion in children with pulmonary artery hypertension. Cardiology in the Young 30: 1024-1025, 803519419 No. 7, Jul 2020. Available from: URL: http://doi.org/10.1017/S1047951120001237
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Reactions 5 Dec 2020 No. 1833
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