From the Research
Weaning a patient off Veletri (epoprostenol) requires a gradual, carefully monitored approach under direct supervision of a pulmonary hypertension specialist, with dose reductions of 1-2 ng/kg/min every 1-2 weeks, and slower reductions as the dose gets lower (below 10 ng/kg/min) 1. The process of weaning a patient off Veletri (epoprostenol) is complex and requires careful consideration of the patient's clinical response, disease severity, and potential for rebound pulmonary hypertension.
- Key considerations in the weaning process include:
- Gradual dose reduction to minimize the risk of hemodynamic instability
- Close monitoring of pulmonary arterial pressure, right heart function, exercise capacity, and symptoms
- Optimization of alternative pulmonary hypertension therapies before and during the weaning process
- Avoidance of abrupt discontinuation to prevent rebound pulmonary hypertension, right heart failure, and potentially death
- The weaning process may take several months, depending on the patient's initial dose, disease severity, and clinical response, and should only be attempted in patients who have demonstrated significant and sustained improvement in their pulmonary hypertension or those transitioning to alternative prostacyclin therapies 1.
- A recent study published in 2023 found that the maximum tolerable dosage of epoprostenol was lower than dosages reported in the literature, and that the up-titration process should be pushed for higher dosages of epoprostenol in the occurrence of side effects, as the achievement of a high and effective dosage is crucial for the clinical benefit of the patients 1.
- Another study published in 2017 highlighted the importance of epoprostenol in the treatment of pulmonary arterial hypertension, and noted that the place of epoprostenol in the therapeutic management of PAH continues to evolve, with the development of new formulations and use in combination with other drug classes 2.