Skip to Content

Treprostinil Dosage

Applies to the following strength(s): 1 mg/mL ; 2.5 mg/mL ; 5 mg/mL ; 10 mg/mL ; 0.6 mg/mL ; 0.125 mg ; 0.25 mg ; 1 mg ; 2.5 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Pulmonary Hypertension

Oral formulation:
Initial dose: 0.25 mg orally every 12 hours with food
Recommended titration: 0.25 or 0.5 mg 2 times daily every 3 to 4 days (if 0.25 mg 2 times daily increments are not tolerated consider titrating slower)
-The total daily dose can be divided and given every 8 hours with food, titrating by increments of 0.125 mg 3 times daily.
Mean dose: 3.5 mg orally every 12 hours with food.
Maximum dose: Determined by tolerability. The maximum dose studied was 21 mg orally every 12 hours with food.

Infusion:
Initial dose: 1.25 nanogram/kg per minute by continuous infusion. The subcutaneous route is preferred but the drug may be administered by a central intravenous line if the subcutaneous route is not tolerated. The rate may be decreased to 0.625 nanogram/kg/minute if the initial dose is not tolerated by the patient.
Maintenance dose: The infusion rate may be increased in increments of no more than 1.25 nanogram/kg/minute per week for the first 4 weeks, and thereafter by no more than 2.5 nanograms/kg/minute per week. Dosage adjustments should be titrated to a dose where PAH symptoms are improved and adverse effects are minimized (headache, nausea, emesis, restlessness, anxiety, and infusion site pain or reaction). Although doses of up to 100 nanograms/kg/minute have been reported, there is little experience with doses greater than 40 nanograms/kg/minute.

Inhalation:
Use only with the Tyvaso (R) Inhalation System. Administer undiluted, as supplied. A single breath of Tyvaso (R) delivers approximately 6 mcg of treprostinil
Initial dosage: 3 breaths [18 mcg] per treatment session. If 3 breaths are not tolerated, reduce to 1 or 2 breaths. Administer in 4 separate treatment sessions each day approximately four hours apart, during waking hours.
Maintenance dose: Dosage should be increased by an additional 3 breaths at approximately 1-2 week intervals, if tolerated. Titrate to target maintenance dosage of 9 breaths or 54 mcg per treatment session as tolerated.

Usual Pediatric Dose for Pulmonary Hypertension

Oral formulation: Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Inhalation:
Less than 16 years: Safety and efficacy have not been established.
16 to 18 years:
Initial dose: 1.25 nanogram/kg per minute by continuous infusion. The subcutaneous route is preferred but the drug may be administered by a central intravenous line if the subcutaneous route is not tolerated. The rate may be decreased to 0.625 nanogram/kg/minute if the initial dose is not tolerated by the patient.
Maintenance dose: The infusion rate may be increased in increments of no more than 1.25 nanogram/kg/minute per week for the first 4 weeks, and thereafter by no more than 2.5 nanograms/kg/minute per week. Dosage adjustments should be titrated to a dose where PAH symptoms are improved and adverse effects are minimized (headache, nausea, emesis, restlessness, anxiety, and infusion site pain or reaction). There is little experience with doses greater than 40 nanograms/kg/minute.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Oral formulation:
Mild hepatic impairment (Child Pugh A): Start dosing at 0.125 mg orally 2 times daily with 0.125 mg increments every 3 to 4 days.
Moderate hepatic impairment (Child Pugh B): Avoid use
Severe hepatic impairment (Child Pugh C) Contraindicated

Infusion:
An initial dose of 0.625 nanogram/kg per minute (ideal body weight) is recommended in patients with mild to moderate hepatic insufficiency.

Inhalation:
Titrate slowly in patients with hepatic insufficiency, because such patients will likely be exposed to greater systemic concentrations relative to patients with normal hepatic function.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Oral formulation: No adjustment recommended.

Infusion or inhalation: Data not available

Other Comments

Oral formulation:
-Take with food.
-Swallow tablets whole. Do not chew,break, or crush.
-Use only whole tablets. Discard any broken tablets.
-Do not take with alcohol.
-Do not discontinue abruptly.

Infusion:
-Treprostinil injection is indicated for continuous infusion administration only.
Patients should have the ability to use a subcutaneous catheter and infusion pump for a prolonged period of time (possibly years).
-Sudden withdrawal or large dosage reduction should be avoided because PAH symptoms may worsen.

Inhalation:
-Treprostinil inhalation must be used only with the Tyvaso (R) Inhalation System.
-Treprostinil injection is preferably administered via a self-inserted subcutaneous catheter using an ambulatory subcutaneous infusion pump. A backup pump and infusion sets should be immediately available to the patient. The manufacturer recommends that the pump be small, lightweight, positive pressure driven, adjustable to 0.002 mL/hour, accurate to plus or minus 6%, and have occlusion/no delivery, low battery, programming error, and motor malfunction alarms. The recommended reservoir is polyvinyl chloride, polypropylene or glass.
-Treprostinil inhalation must be used only with the Tyvaso (R) Inhalation System. Patients should follow the instructions for use for operation of the Tyvaso (R) Inhalation System and for daily cleaning of the device components after the last treatment session of the day. To avoid potential interruptions in drug delivery because of equipment malfunction, patients should have access to a back-up Optineb-ir device.
-Treprostinil can be administered as supplied or diluted for intravenous infusion with Sterile Water for Injection, 0.9% Sodium Chloride Injection, Sterile Diluent for Flolan, or Sterile Diluent for Epoprostenol Sodium prior to administration.

Hide