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Transition Therapy in Pulmonary Vascular Disease

Strategies for transitioning from oral to parenteral therapy and treatment escalation in pulmonary hypertension

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göğüs Hastalıkları department. Book Appointment →

What is Transition Therapy in Pulmonary Vascular Disease?

Transition therapy in pulmonary vascular disease covers strategies for escalating to parenteral prostacyclin therapy in pulmonary arterial hypertension (PAH) patients who fail to achieve adequate response with oral therapies, and the management of this transition.

In patients who remain in the intermediate-low or intermediate-high risk category despite combination oral ERA and PDE5 inhibitor therapy, addition of a third agent or transition to parenteral prostanoid therapy may be required. This decision should be made at specialized PAH centers.

IV epoprostenol is a drug requiring continuous infusion with a very short half-life; it is administered through a central venous catheter and a portable pump. SC treprostinil is delivered through subcutaneous infusion and represents a more practical alternative.

Hemodynamic monitoring, dose titration, and patient education are critical during the transition. Infection prevention is the most important component of care for patients with central catheters.

Symptoms

Clinical conditions requiring treatment escalation:
Worsening NYHA functional class on oral therapy
Decline in 6-minute walking distance
Increased signs of right heart failure
Rising BNP/NT-proBNP levels
Worsening hemodynamics on right heart catheterization

Risk Factors

Central venous catheter infection (IV epoprostenol)
Infusion pump malfunction (potentially life-threatening)
SC treprostinil infusion-site pain and reaction
Rebound pulmonary hypertension (when infusion is interrupted)
Severe hypotension (during dose titration)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Worsening symptoms on oral therapy
  • Signs of catheter infection during parenteral therapy
  • Technical problems with the infusion system (emergency)

Treatment Methods

01
IV epoprostenol continuous infusion (most potent prostanoid)
02
SC treprostinil (continuous subcutaneous infusion)
03
Inhaled iloprost or treprostinil (less invasive option)
04
Oral selexipag (IP receptor agonist, prostacyclin pathway)
05
Patient and caregiver education (pump management, catheter care)
06
Regular risk assessment and treatment-response monitoring

Which Department to Visit?

You can visit our Göğüs Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Göğüs Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.