Abstract | OBJECTIVES: BACKGROUND: Patients on prostacyclin require chronic upward dose titration to overcome tolerance to the medication. No upper limit of effective dose has been described. METHODS: RESULTS: Patients were treated for 39 +/- 20 months, resulting in a 71% reduction in pulmonary vascular resistance compared to baseline. At the time of their most recent evaluation their cardiac outputs were increased to 10.1 +/- 2.3 liter/min. The patients underwent a 39% dose reduction (range 12% to 78%) resulting in a change of mean PAP from 45 to 46 mm Hg (p = NS), cardiac index from 7.4 +/- 1.4 to 4 +/- 0.74 liter/min/M2 (p = 0.01), and pulmonary vascular resistance from 3.7 +/- 1.7 to 4.7 +/- 1.5 units (p < 0.001). In no instance did rebound pulmonary hypertension occur. However, the patients all retained their clinical benefit without a return of tolerance. CONCLUSIONS: Excessive prostacyclin in PPH can lead to a high cardiac output state, suggesting it has important positive inotropic effects. In this circumstance, reducing the dose can allow the cardiac output to return to normal without worsening the clinical state.
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Authors | S Rich, V V McLaughlin |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 34
Issue 4
Pg. 1184-7
(Oct 1999)
ISSN: 0735-1097 [Print] United States |
PMID | 10520810
(Publication Type: Journal Article)
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Chemical References |
- Antihypertensive Agents
- Epoprostenol
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Topics |
- Adult
- Aged
- Antihypertensive Agents
(administration & dosage, adverse effects)
- Cardiac Output
(drug effects)
- Dose-Response Relationship, Drug
- Drug Tolerance
- Epoprostenol
(administration & dosage, adverse effects)
- Female
- Hemodynamics
(drug effects)
- Humans
- Hypertension, Pulmonary
(drug therapy)
- Long-Term Care
- Male
- Middle Aged
- Renin-Angiotensin System
(drug effects)
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