subcutaneous to intravenous treprostinil, bearing in mind that higher doses may be needed, and particular attention should be paid to sterility of manipulations. It has been the experience in expert centers in general that prostacyclin-type side effects tend to be less severe with treprostinil than with epoprostenol, allowing for more rapid increase in dosing and symptomatic relief. The reasons for this better tolerance of treprostinil are unclear, but may be related to less rapid increases in plasma levels. Disclosures None of the authors has any conﬂicts of interest to disclose. References Badesch DB, Abman SH, Simonneau G, et al. 2007. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest, 131:1917–28. Badesch DB, Tapson VF, McGoon MD, et al. 2000. Continuous intrave- nous epoprostenol for pulmonary hypertension due to the scleroderma spectrum of disease. A randomized, controlled trial. Ann Intern Medi, 132:425–34. Barst RJ, Galie N, Naeije R, et al. 2006. Long-term outcome in pulmonary arterial hypertension patients treated with subcutaneous treprostinil. Eur Respir J, 28:1195–203. Barst RJ, Rubin LJ, Long WA, et al. 1996. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. N Engl J Med, 334:296–301. Centers for Disease Control and Prevention (CDC). 2007. Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension, seven sites, United States. Morb Mortal Wkly Rep, 56:170–2. Channick RN, Olschewski H, Seeger W, et al. 2006. Safety and efﬁcacy of inhaled treprostinil as add-on therapy to bosentan in pulmonary arterial hypertension. J Am Coll Cardiol, 48:1433–7. Farber HW, Loscalzo J. 2004. Pulmonary arterial hypertension. N Engl J Med, 351:1655–65. Galie N, Torbicki A, Barst R, et al. Task Force. 2004. Guidelines on diag- nosis and treatment of pulmonary arterial hypertension. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology. Eur Heart J, 25:2243–78. Gomberg-Maitland M, Tapson VF, Benza RL, et al. 2005. Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension. Am J Respir Crit Care Med, 172:1586–9. Higenbottam TW, Spiegelhalter D, Scott JP, et al. 1993. Prostacyclin (epoprostenol) and heart-lung transplantation as treatments for severe pulmonary hypertension. Br Heart J, 70:366–70. Hoeper MM, Mayer E, Simonneau G, et al. 2006. Chronic thromboembolic pulmonary hypertension. Circulation, 113:2011–20. Humbert M, Sitbon O, Simonneau G. 2004. Treatment of pulmonary arterial hypertension. N Engl J Med, 351:1425–36. Humbert M, Sitbon O, Chaouat A, et al. 2006. Pulmonary arterial hyperten- sion in France: results from a national registry. Am J Respir Crit Care Med, 173:1023–30. Kuo PC, Plotkin JS, Howell CD, et al. 1997. Continuous infusion of epo- prostenol for the treatment of portopulmonary hypertension. Trans- plantation, 63:604–6. Laliberte K, Arneson C, Jeffs R, et al. 2004. Pharmacokinetics and steady-state bioequivalence of treprostinil sodium (Remodulin) admin- istered by the intravenous and subcutaneous route to normal volunteers. J Cardiovasc Pharmacol, 44:209–14. Treprostinil for pulmonary hypertension Lang I, Gomez-Sanchez M, Kneussl M, et al. 2006. Efﬁcacy of long-terms subcutaneous treprostinil sodium therapy in pulmonary hypertension. Chest, 129:1636–43. McLaughlin V, Presberg KW, Doyle RL, et al. 2004. Prognosis of pulmonary arterial hypertension* ACCP evidence-based clinical practice guide- lines. Chest, 126:78S–92S. McLaughlin VV, Shillington A, Rich S. 2002. Survival in primary pulmo- nary hypertension: the impact of epoprostenol therapy. Circulation, 106:1477–82. McSwain CS, Benza R, Shapiro S, et al. 2008. Dose proportionality of treprostinil sodium administered by continuous subcutaneous and intravenous infusions. J Clin Pharmacol, 48:19–25. Naeije R, Vachiery JL. 2001. Medical therapy of pulmonary hypertension: conventional therapies. Clin Chest Med, 22:517–28. Nagaya N, Sasaki N, Ando M, et al. 2003. Prostacyclin therapy before pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Chest, 123:338–43. Nunes H, Humbert M, Sitbon O, et al. 2003. Prognostic factors for survival in human immunodeﬁciency virus-associated pulmonary arterial hyper- tension. Am J Respir Crit Care Med, 167:1433–9. Peacock AJ, Murphy NF, McMurray JJV, et al. 2007. An epidemiological study of pulmonary arterial hypertension. Eur Respir J, 30:104–9. Phares KR, Weiser WE, Miller SP, et al. 2003. Stability and preservative effectiveness of treprostinil sodium after dilution in common intrave- nous diluents. Am J Health Syst Pharm, 60:916–22. Provencher S, Sitbon O, Humbert M, et al. 2006. Long-term outcome with ﬁrst-line bosentan therapy in idiopathic pulmonary arterial hypertension. Eur Heart J, 27:589–595. Robbins IM, Christman BW, Newman JH, et al. 1998. A survey of diagnostic practices and the use of epoprostenol in patients with primary pulmonary hypertension. Chest, 114:1269–75. Rosenzweig EB, Kerstein D, Barst RJ. 1999. Long-term prostacyclin for pulmonary hypertension with associated congenital heart defects. Circulation, 99:1858–65. Rubenﬁre M, McLaughlin VV, Allen RP, et al. 2007. Transition from IV epoprostenol to subcutaneous treprostinil in pulmonary arterial hyper- tension: a controlled trial. Chest, 132:757–63. Simonneau G, Barst RJ, Galié N, et al. 2002. Continuous subcutaneous infu- sion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension. Am J Respir Crit Care Med, 162:800–4. Simonneau G, Galie N, Rubin LJ, et al. 2004. Clinical classiﬁcation of pulmonary hypertension. J Am Coll Cardiol, 43(12 Suppl S):5S–12S. Sitbon O, Humbert M, Nunes H, et al. 2002. Long-term intravenous epopro- stenol infusion in primary pulmonary hypertension: prognostic factors and survival. J Am Coll Cardiol, 40:780–8. Sitbon O, Manes A, Jais X, et al. 2007. Rapid switch from intravenous epoprostenol to intravenous treprostinil in patients with pulmonary arterial hypertension. J Cardiovasc Pharmacol, 49:1–5. Skoro-Sajer N, Bonderman D, Wiesbauer F, et al. 2007. Treprostinil for severe inoperable chronic thromboembolic pulmonary hypertension. J Thomb Haemost, 5:483–9. Tapson VF, Gomberg-Maitland M, McLaughlin VV, et al. 2006. Safety and efﬁcacy of iv treprostinil for pulmonary arterial hypertension: a prospec- tive, multicenter, open-label, 12-week trial. Chest, 129:683–8. Vachiery JL, Hill N, Zwicke D, et al. 2002. Transitioning from i.v. epopro- stenol to subcutaneous treprostinil in pulmonary arterial hypertension. Chest, 121:1561–5. Vachiery JL, Naeije R. 2004. Treprostinil for pulmonary hypertension. Expert Rev Cardiovasc Ther, 2:183–91. Wade M, Baker FJ, Roscigno R, et al. 2004. Absolute bioavailability and pharmacokinetics of treprostinil sodium administered by acute subcu- taneous infusion. J Clin Pharmacol, 44:83–8. Wade M, Hunt TL, Lai AA. 2003. Effect of continuous subcutaneous treprostinil therapy on the pharmacodynamics and pharmacokinetics of warfarin. J Cardiovasc Pharmacol, 41:908–15. Vascular Health and Risk Management 2008:4(3) 513