A longer-acting prostacyclin for high blood pressure in the lung arteries
Treprostinil
A longer-acting prostacyclin given by continuous infusion under the skin or into a vein for pulmonary arterial hypertension; infusion-site pain is common.
What is Treprostinil?
Treprostinil is a longer-acting prostacyclin medicine used to treat pulmonary arterial hypertension, which is high blood pressure in the arteries of the lungs. It relaxes and widens the lung arteries to ease breathlessness and help the heart. It is usually given as a continuous infusion either under the skin or into a vein, and because it lasts longer than epoprostenol it is more forgiving of brief interruptions. With the under-the-skin form, pain and tenderness where the needle sits are very common. It is started and supervised by a specialist pulmonary hypertension centre. Inhaled and oral forms also exist.
Education and reference only. This is a plain-language guide to Treprostinil — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Treprostinil is a man-made prostacyclin-like medicine for pulmonary arterial hypertension, a serious condition where the pressure in the lung arteries is too high. It works like prostacyclin but lasts longer in the body, so it can be given as a continuous infusion either just under the skin (subcutaneous) or into a vein (intravenous), driven by a small pump. Inhaled and oral forms are also available in some settings. It is a specialist treatment prescribed through pulmonary hypertension services in the UK.
How it works
Prostacyclin normally keeps blood vessels relaxed and open. In pulmonary arterial hypertension there is too little of it, so the lung arteries stay narrowed. Treprostinil acts like prostacyclin to relax and widen the lung arteries, lowering the pressure the heart pumps against and easing breathlessness. Because it lasts longer than epoprostenol, the continuous infusion is steadier and brief interruptions are less risky, though it should still not be stopped without advice.
Company & origin
Originated / developed by: United Therapeutics (originator).
A longer-acting prostacyclin medicine used in the UK by specialist centres to treat pulmonary arterial hypertension.
Practical use
How to take Treprostinil
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given as a continuous infusion under the skin or into a vein using a small pump, set up and managed by your specialist centre.
- With the under-the-skin form, expect site pain or tenderness; tell your team, who can advise on managing it and on changing sites.
- If you have the intravenous form, follow the strict sterile line care you are taught to lower the risk of infection.
- Do not stop the infusion without advice, even though it is more forgiving of brief interruptions than some other prostacyclins.
- Report severe or worsening site pain, signs of line infection such as fever, or sudden worsening of breathlessness.
Weighing it up
Advantages & disadvantages of Treprostinil
Advantages
- Longer-acting than epoprostenol, so it gives a steadier effect and is more forgiving of brief interruptions.
- Can be given under the skin, which avoids the need for a permanent line in some people.
- Available in several forms, including inhaled and oral, giving flexibility in specialist care.
Disadvantages
- The under-the-skin form commonly causes pain and tenderness at the infusion site.
- Still needs a continuous infusion and pump, with the intravenous form carrying a line-infection risk.
- Causes flushing, jaw pain, headache, diarrhoea and low blood pressure from its blood-vessel action.
Practical use
Good to know
Treprostinil is a specialist medicine, set up and supervised by a pulmonary hypertension centre, who train you to manage the infusion and pump. Its longer action makes it more forgiving than epoprostenol if the infusion is briefly interrupted, but it should still not be stopped without advice. The most distinctive practical issue is with the under-the-skin (subcutaneous) form: pain, redness and tenderness where the small needle sits are very common and can be hard to tolerate, and your team can suggest ways to manage this. The intravenous form avoids site pain but, like any permanent line, carries a risk of line infection. Common effects from its blood-vessel action include flushing, jaw pain, headache, diarrhoea and low blood pressure.
Who should not take it / use with caution
- People who cannot safely manage a continuous infusion and pump, even with support, may not be suitable.
- It is avoided in people at high risk of bleeding, because it affects how blood clots.
- It is used with caution in those with very low blood pressure or significant liver or kidney problems.
Monitoring
- Review of infusion-site comfort and the line, with watch for site pain or infection.
- Monitoring of blood pressure, any dizziness and the response to treatment.
- Regular specialist review of breathlessness, exercise capacity and overall response.
Side effects
- Pain, redness and tenderness at the infusion site, especially with the under-the-skin form, are very common.
- Flushing, jaw pain, headache and diarrhoea.
- Low blood pressure and, with the intravenous form, line-related infection.
Key interactions
- Adds to the blood-pressure-lowering effect of other medicines, increasing the risk of dizziness.
- Adds to the effect of blood-thinning and anti-platelet medicines, raising bleeding risk.
- Used alongside other pulmonary hypertension medicines under specialist supervision.
Available as: A solution given by continuous infusion under the skin or into a vein using a pump; inhaled and oral forms are also available.
Answers
Treprostinil: frequently asked questions
Why does the infusion site hurt?
Pain and tenderness where the needle sits are very common with the under-the-skin form; tell your team, who can advise on managing it and changing sites.
How is it different from epoprostenol?
Treprostinil lasts longer in the body, so the infusion is steadier and brief interruptions are less risky, though it should still not be stopped without advice.
Can it be given without a needle under the skin?
Yes, it can also be given into a vein through a line, and inhaled and oral forms exist; your specialist team decides which form suits you.
Why do I get flushing and jaw pain?
These come from treprostinil widening blood vessels and are common; they often settle, but tell your team if they are troublesome.
Who manages this treatment?
It is a specialist treatment set up and supervised by a pulmonary hypertension centre, who train you to manage the infusion and pump.
Authoritative sources
- BNF
- NICE CKS
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