Abstract Continuous
prostanoid infusions are recommended for patients with advanced
pulmonary arterial hypertension. Infusion site
pain has discouraged some physicians from considering subcutaneous (SQ)
treprostinil therapy even though it has safety and convenience advantages over intravenous
epoprostenol. We conducted a 1-year prospective study of patients utilizing SQ
treprostinil. We provided counseling on infrequent site changes and a written
analgesic protocol including
narcotics. After placement of a new site, subjects recorded daily
pain scores and
analgesic use. Twenty-six of 29 patients consented, including 4 patients who had recently started
therapy. They returned 203 diaries, and we captured every site change in a diary. Sixteen subjects returned 8 or fewer diaries during 12 months, and 20% of diaries documented only mild discomfort. The majority of diaries documented brief periods of severe
pain, but this had generally abated by day 7. Contrary to published guidelines, infusion site
pain was independent of
treprostinil dose in a rigorous analysis. There were 3 significant local reactions but no systemic illness. No subject discontinued SQ
treprostinil because of site discomfort. Subjects reported satisfaction with their treatment using a validated assessment, and quality-of-life scores were favorable. A strategy emphasizing infrequent site changes and early
analgesia can facilitate use of SQ
treprostinil. These data may allow physicians to consider
treprostinil earlier in the treatment algorithm for this fatal disease.