Treprostinil
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Treprostinil Hypotension and drowsy consciousness: case report
A 43-year-old woman developed hypotension and drowsy consciousness following transition to IV treprostinil for idiopathic pulmonary arterial hypertension (IPAH). The woman, who had a history of IPAH, had been undergoing treatment with maximal target medications including SC treprostinil. In June 2018, she developed high-risk warning signs and received SC treprostinil injection titrated up to 90 ng/kg/min. However, despite maximum medical treatment, she developed worsening right heart failure with associated symptoms and was admitted in December 2018. Her ascites were drained in two sessions. Her injection site was moved from the ascites to her arm for better SC absorption of treprostinil. On day 3 of admission, a transition from SC treprostinil to IV treprostinil infusion was planned at 1:1 dosage. However, the conversion to IV treprostinil led to the development of profound hypotension with a systolic BP of 60mm Hg, along with drowsy consciousness [durations of treatment to reactions onset not stated]. The woman’s IV treprostinil dose was reduced from 90 ng/kg/min to 65 ng/kg/min and unspecified inotropic treatment was initiated. Her BP normalised and she regained consciousness within 2 hrs. On day 4 and 7 of admission, her IV treprostinil was titrated up to 82 ng/kg/min. Five days later, she underwent balloon atrial septostomy under intracardiac echocardiography and her condition improved. Before discharge, she was transitioned back to SC treprostinil from IV treprostinil over 2 days without adverse reactions, for easier self-care at home. Six months later, her condition worsened and her ascites and dyspnoea increased. She then underwent second and third sessions of balloon atrial septostomy resulting in resolution of symptoms. One month after the third session, she was permanently transitioned from SC to IV treprostinil infusion via peripherally inserted central catheter. Liang K-W, et al. Balloon atrial septostomy and transition of subcutaneous to intravenous prostacyclin infusion for rescuing advanced right heart failure in idiopathic pulmonary arterial hypertension: A case report. European Heart Journal - Case Reports 4: No. 3, Jun 2020. Available from: URL: http://doi.org/10.1093/ehjcr/ ytaa052
0114-9954/20/1834-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
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Reactions 12 Dec 2020 No. 1834
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