Prostacyclin Forms

Inhaled prostacyclin
Oral prostacyclin
Infused prostacyclin

Administration forms

Prostacyclin-class therapies can be delivered via 3 routes of administration: inhaled, oral, and infused. Each form has specific characteristics and side effects, allowing patients and providers to tailor therapies to suit their needs.¹ Additionally, patient support is provided through specialty pharmacies to help initiate and manage prostacyclin therapies.

This content is an overview of prostacyclin-class therapies and not a comprehensive list. Please review each label carefully for specific information about individual medications.

Inhaled prostacyclin

Inhaled forms of prostacyclin-class therapy allow for delivery of the medication directly to the distal airways affected in pulmonary arterial hypertension (PAH). This optimizes therapeutic responses and reduces systemic effects.^2-8 Inhaled prostacyclin-class therapies are available in 2 forms: nebulizers and small, handheld DPI devices.^4,5,7,8

When to consider inhaled therapy

Inhaled prostacyclin-class therapy is typically used in patients who are at intermediate-low risk status.^1,9 Inhaled forms of prostacyclin-class therapies were studied as add-ons to regimens that included a PDE-5i and/or an ERA.^5,7,8 Patients who are inappropriate for or refuse infused prostacyclin-class therapies may be appropriate candidates for inhaled prostacyclins.^5,9

Inhaled therapies to help manage PAH

Treatment with inhaled prostacyclin-class therapies may aid your patients in multiple ways. Patients on inhaled prostacyclin-class therapies improved their 6MWD, some in as early as 6 to 8 weeks after initiation.^4,5,10 In clinical studies, many patients exhibited improvement in hemodynamics, including PVR and mPAP, with inhaled therapies.^4,11,12 These findings from clinical studies suggest that patients may improve their risk parameters with inhaled prostacyclin-class therapies.^8,13

Inhaled options for individualized therapy

Titration and dose escalation to treatment effect can be readily achieved with inhaled prostacyclins by changing dosage strengths (DPIs) or increasing the number of breaths (nebulizers).^5,7,8

Because inhaled prostacyclin-class therapy is available as a DPI or as a nebulized solution, you can help patients choose the right option for them.^4,8,14

DPI devices are small, pocket-sized inhalers that are easy to use for patients and can be carried with them
Nebulizer devices are portable, electronic, and require daily setup and maintenance

Side effects of inhalation therapies*

In addition to general prostacyclin-class therapy side effects, there are side effects specific to the inhalation forms themselves. These include cough and throat irritation.^4-8,15

Proactive management of side effects may help your patients stay compliant on these important therapies.^1,15,16

*This is not an all-inclusive list of side effects. Please consult each individual label for a complete list.

Oral prostacyclin

Oral forms of prostacyclin-class therapy are available in multiple dose strengths, are titratable, and are typically taken 2 or 3 times daily.^17,18

For use in intermediate-risk patients

Oral prostacyclin-class therapy may be an option in patients who are at intermediate-low to intermediate-high risk status.^1,19 Patients who are inappropriate for or refuse infused prostacyclins may be appropriate candidates for oral prostacyclins.²⁰

Oral therapies to help manage PAH

Oral forms of prostacyclin class therapies have been studied in combination treatment regimens.^17,18 Oral forms of prostacyclin were shown to improve parameters of risk, delay disease progression, and reduce clinical worsening.^1,17,18 Other improvements included increased 6MWD and decreased NT-proBNP measurements.^17,18 Patients in clinical trials also had improved hemodynamics, including PVR and CI.^1,21,22

Tailor therapies to your patients’ goals

Titration and dose escalation to therapeutic effect may help support your patients’ changing clinical needs while addressing their lifestyle goals. Dosing may be 2 or 3 times daily, and the doses are easily titratable, up or down, according to your patients' needs.^17,18 Talk with your patients to determine their treatment goals and risk status.

Side effects of oral therapy*

In addition to general prostacyclin-class therapy side effects, there are side effects specific to the oral forms themselves. These include additional vomiting, jaw pain, and pain in extremities.^1,17,18

Proactive management of side effects may help your patients stay compliant on these important therapies.^1,15,16

*This is not an all-inclusive list of side effects. Please consult each individual label for a complete list.

Infused prostacyclin

Infused therapies provide continuous, 24-hour medication delivery through SC or IV routes. Several pump options are available, including one that is small and lightweight.^15,16

Critical treatment for higher-risk patients

Infused prostacyclin-class therapies are considered in patients at intermediate-high and high-risk status and patients who are progressing quickly with signs of right heart failure.^1,9

Infused therapies to help manage PAH

In clinical studies, treatment by infused therapies improved patients' symptoms of fatigue and shortness of breath.^23,24 Patients also improved their risk parameters, increased their exercise capacity, and had improved right heart hemodynamics, including CI, mPAP, mRAP, and SvO₂.^23-26 The biomarker NT-proBNP also decreased.²⁷

Lifestyle with infused prostacyclins

With advancing technology, SC pumps have become even smaller than IV pumps, with no premixing required, and may be an option for your patients. IV infusions may be started in the hospital, but patients can be transitioned to SC or IV pumps for home use.

Titration and dose escalation can be achieved with all infusion forms of prostacyclin-class therapies, addressing changes in a patient’s disease status.^23-25

Side effects of infused therapy*

In addition to general prostacyclin-class therapy side effects, there are side effects specific to the infused forms themselves. These include infusion site pain and reactions, erythema/redness, pain, bleeding, bloodstream infections, and swelling.^15,24,25

Proactive management of side effects may help your patients stay compliant on these important therapies.^1,15,16

*This is not an all-inclusive list of side effects. Please consult each individual label for a complete list.

CI=cardiac index; DPI=dry powder inhaler; ERA=endothelin receptor antagonist; IV=intravenous; mPAP=mean pulmonary arterial pressure; mRAP=mean right atrial pressure; NT‑proBNP=N-terminal pro–B-type natriuretic peptide; PDE-5i=phosphodiesterase-5 inhibitor; PCWP=pulmonary arterial wedge pressure; PVR=pulmonary vascular resistance; RAP=right atrial pressure; SC=subcutaneous; SvO₂=mixed venous oxygen saturation; SVR=systemic vascular resistance.

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