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Yutrepia
treprostinil inhaled
Adult Dosing .
Dosage forms: DPI: 26.5 mcg per cap, 53 mcg per cap, 79.5 mcg per cap, 106 mcg per cap
Special Note
- [strength clarification]
- Info: 1 cap = 2 breaths; doses expressed as treprostinil amount
pulmonary arterial HTN
- [treprostinil tx-naive patients]
- Dose: 79.5-106 mcg inhaled qid; Start: 26.5 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 30 mcg (5 breaths) or less per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 26.5 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 36-48 mcg (6-8 breaths) per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 53 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 54-66 mcg (9-11 breaths) per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 79.5 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 72-84 mcg (12-14 breaths) per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 106 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 90-102 mcg (15-17 breaths) per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 132.5 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 108 mcg (18 breaths) or more per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 159 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
pulmonary HTN, interstitial lung disease-associated
- [treprostinil tx-naive patients]
- Dose: 79.5-106 mcg inhaled qid; Start: 26.5 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 30 mcg (5 breaths) or less per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 26.5 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 36-48 mcg (6-8 breaths) per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 53 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 54-66 mcg (9-11 breaths) per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 79.5 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 72-84 mcg (12-14 breaths) per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 106 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 90-102 mcg (15-17 breaths) per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 132.5 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
- [conversion from treprostinil NEB 108 mcg (18 breaths) or more per dose]
- Dose: 79.5-106 mcg inhaled qid; Start: 159 mcg inhaled 3-5x/day, may incr. by 26.5 mcg/dose qwk as tolerated; Max: 848 mcg/day
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised; Info: titrate slowly
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: hepatic impairment
- caution: asthma
- caution: reactive airway disease
- caution: COPD
- caution: pulmonary infection, acute
- caution: hypotension
- caution: bleeding risk
Drug Interactions .
Overview
treprostinil
prostacyclin vasodilator
- CYP2C8 substrate
- antiplatelet effects
- vasodilator agent
Avoid/Use Alternative
Monitor/Modify Tx
Caution Advised
Adverse Reactions .
Serious Reactions
- hypotension, severe
- syncope
- bleeding
- angioedema
- bronchospasm
Common Reactions
- cough
- headache
- throat irritation
- pharyngolaryngeal pain
- nausea
- dizziness
- flushing
- diarrhea
- dyspnea (DPI form)
- syncope
- myalgia
- bone pain
- jaw pain
Safety/Monitoring .
Monitoring Parameters
BP
Pregnancy/Lactation .
Pregnancy
Clinical Summary
benefits outweigh risks during pregnancy; no human data available with inhaled form, though risk of fetal harm not expected based on limited human data with injectable form
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available with inhaled form, though risk of infant harm not expected based on drug properties; no known risk of infant harm based on limited human data with injectable form; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for treprostinil: liver extensively; CYP450: 2C8 (primary), 2C9 substrate
Excretion: for treprostinil: urine 79% (4% unchanged), feces 13%; Half-life: 27-50min
Subclass: Interstitial Lung Disease ; Pulmonary Arterial Hypertension (PAH)
Mechanism of Action
for treprostinil: dilates pulmonary and systemic vessels, inhibits platelet aggregation and smooth muscle cell proliferation (prostacyclin analog)
Formulary .
No Formulary Selected
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