Initiation and Titration of pulmonary vasoldilators

Pulmonary vasodilators are used in the treatment of treatment of pulmonary hypertension.

• Flolan (Epoprostenol) - the first drug approved by FDA; specifically pulmonary arterial hypertension, as well as pHTN related to scleroderma, lupus, congeital heart disease, diet-pill associated and stimulant associated pHTN

  • Delviered by continuous infusion

  • Mixed on a daily basis and refridgerated

• Veletri (Epoprostenol) - used in PAH as well as pHTN related to scleroderma, lupus, congeital heart disease. It is for patients with severe disease that have not responded to conventional therapy.

  • Delivered by continuous infusion via an ambulatory infusion pump

  • Requires less frequent mixing and does not have to be continuously refriderated

• Remodulin (Treprostinil) - structulrally related to Flolan; approved for PAH, pulmonay hypertension 2/2 connective tissue dsiease. Some experience of this drug in congenital heart disease. Studies have shown it increases exercise tolerance and decreased PA pressure

  • Delivered via continuous infusion either intravenous or subcutaneous through a CAD pump

  • Does not need to be mixed or refridgerated, although pain at infusion site for the subcutaneous route is a significant problem for many patients

  • Perioidic monitoring of blood counts is required

• Iloprost (Ventavis) - approved for use in pateitns with WHO group I pHTN (idiopathic PAH, familial PAH, assocaited PAH)

  • Inhaled via nebulizer; recommended use 6-9 times daily

  • Usu less flushing and diarrhea

https://med.stanford.edu/wallcenter/patient_care/patient-resources/fda.html