One of the treatment options for NYHA class III and IV pulmonary hypertension is prostanoids. All of the prostanoid formulations have the limitations of a short half-life and a heterogeneous response to therapy. Because the drugs need to be given by continuous infusion, patients may present to the ED due to pump failure. Sudden cardiopulmonary collapse can occur with infusion interruption. Here are some important points to remember regarding kinetics:
Intravenous epoprostenol (Flolan®) has an extremely short half-life (2–3 min) and lacks stability at room temperature. Interruption of the pump for even a short period can have drastic consequences.
Treprostinil (Remodulin®) has theoretical advantages over epoprostenol because of its stability at room temperature, an elimination half-life of 4-6 hours (subcutaneous), and its ability to be administered by continuous subcutaneous infusion.
