|
PDE-5 inhibitor |
Sildenafil |
N/A |
20mg TID |
Hypotension, headache, epistaxis, visual changes, diziness |
Contraindicated sGC with nitrates and stimulators |
|
PDE-5 inhibitor |
Tadalafil |
N/A |
40mg OD |
Headache, flushing, hypotension, epistaxis, visual changes |
Contraindicated with nitrates and sGC stimulators |
|
ERA |
Bosentan |
N/A |
Initial 62.5mg BID then up-titration to 125mg BID |
Anemia, fluid retention |
Potential hepatotoxicity, decrease in hemoglobin concentrations, teratogenicity, avoid administration with CYP3A4 and |
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CYP2C9 inhibitors |
|
ERA |
Macitentan |
N/A |
10mg OD |
Anemia, edema, nasopharyngitis, moderate elevation in liver tests |
Teratogenicity |
Oral |
ERA |
Ambrisentan |
N/A |
Initial 5mg OD then up-titration to 10mg OD |
Edema, headache, migraine, nasopharyngitis, moderate elevation in liver test |
Severe hepatic impairment (with or without cirrhosis), teratogenicity |
|
Stimulator of sGC |
Riociguat |
N/A |
Initial 0.5mg TID then up-titration to 2.5mg TID |
Hypotension, anemia, gastrointestinal distress, headache, gastritis, hemoptysis |
Contraindicated with nitrates and PDE-5 inhibitors, teratogenicity |
|
Synthetic analogue of prostacyclin |
Treprostinil |
N/A |
Initial 0.25mg BID or 0.125mg TID, then up-titration to 0.25-0.5mg BID or 0.125mg TID every 3-4 days to the highest tolerated dose |
Hypotension, gastrointestinal distress, headache |
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|
Selective prostacyclin receptor agonist |
Selexipag |
N/A |
Initial 200mcg BID, then up-titration weekly with 200mcg BID to a maximum tolerated dose of 1600mcg BID |
Hypotension, gastrointestinal distress, myalgias |
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|
Synthetic analogue of prostacyclin |
Epoprostenol (Flolan®) |
YES |
Continuous intravenous, in acute setting starting at 1-2ng/kg/min, step by step dose escalation at an interval of minimum 15 minutes 1- to 2- ng/kg/min depending on clinical response |
Tachycardia, flushing, hypotension, headache, diarrhoea, jaw pain, muscle aches, dizziness |
Short half-time (3-5 minutes) At 25°C old formula is stable for only 8 hours; new formula is stable for up to 72h |
|
Synthetic analogue of prostacyclin |
Epoprostenol (Veletri®) |
YES |
Continuous intravenous, in acute setting: 1-2 ng/kg/min and increased by increments of 2 ng/kg/min every 15 minutes or longer depending on clinical response |
Hypotension, headache, jaw pain, muscle aches, agitation, anxiety, flushing, anorexia, photosensitivity, catheter-related infection |
Stable at 25°C for 48h at concentrations of 3000<60000 ng/ mL and for 72h at concentrations >60000 ng/mL |
Parenteral |
Synthetic analogue of prostacyclin |
Treprostinil |
N/A |
Continuous intravenous or subcutaneously initiated at 1.25ng/ kg/min, rising the dose by 1.25 ng/kg/min per week during the first month and then 2.5ng/kg/ min per week, depending on the clinical response |
Flushing, hypotension, headache, gastrointestinal distress, diarrhoea, jaw pain, myalgias; infusion site pain (subcutaneously administration) |
Stable at room temperature |
|
PDE-5 inhibitor |
Sildenafil |
YES |
In acute setting bolus 0.05-0.43mg/kg, usually 10-20mg, then continuous infusion starts at 1.25 mg/ hour with a maximum effect in 20 minutes |
Similar as in orally administration |
Similar as in orally administration |
|
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Synthetic analogue of prostacyclin |
Epoprostenol |
YES |
In acute setting 30-40ng/kg/min, over 10-20 minutes, inhaled or nebulisation |
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Inhaled |
Synthetic analogue of prostacyclin |
lloprost |
YES |
In acute setting 2.5-5 mg 6-9 times per day |
Cough, headache, hemoptysis, gastrointestinal distress |
|
|
analogue Synthetic of prostacyclin |
Treprostinil |
N/A |
18-54 mg 4 times a day |
Cough, headache, hemoptysis, gastrointestinal distress |
|