# Escalating Oral Treprostinil Dose With Intravenous Treprostinil Bridging Therapy

## TL;DR

A patient with pulmonary arterial hypertension was successfully treated by increasing oral treprostinil with intravenous bridging therapy.

## Contribution

This case demonstrates a novel approach to dose optimization using intravenous treprostinil to bridge oral dose escalation.

## Key findings

- Intravenous treprostinil allowed for rapid bridging to higher oral doses.
- The patient experienced improved symptoms and right ventricular function.
- This approach enabled successful dose escalation previously hindered by adverse effects.

## Abstract

Oral treprostinil, approved for the treatment of pulmonary arterial hypertension, remains an attractive option in combination with other medications to delay disease progression and improve exercise capacity. However, patients are often challenged with the ability to overcome adverse effects as outpatients and reach effective doses in a timely manner. We describe a case of a 47-year-old female on oral treprostinil who presented to the clinic with worsening symptoms of disease, necessitating higher dosing. This patient was previously uptitrated outpatient with oral treprostinil, which had allowed her to remain stable for years. Once uptitrated with additional intravenous therapy, the oral treprostinil dose was gradually further increased to the new goal dosage, resulting in improvements in symptoms and right ventricular function. This case highlights the versatility of dose optimization of oral treprostinil with rapid bridging through intravenous therapy.