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Orenitram

treprostinil

Used for Pulmonary Hypertension

Orenitram (treprostinil) is used to treat pulmonary arterial hypertension (PAH) to improve your ability to exercise. The medication is available as a tablet that's easy to take, but it needs to be taken two or three times a day. It's only available as a brand medication, which can make it expensive.

Reviewed by:

Dalga Surofchy, PharmD, APh

Allison Gourley, PharmD

Last reviewed on July 22, 2021

Basics Side effects Pros & cons Pharmacist tips FAQs Warnings Dosage Alternatives Latest news Prices Medicare

What is Orenitram (treprostinil)?

What is Orenitram (treprostinil) used for?

Pulmonary arterial hypertension (PAH)

How Orenitram (treprostinil) works

Orenitram (treprostinil) is a prostacyclin analog, which means that it acts like prostacyclin. Prostacyclin is a natural hormone in your body that helps widen or open up the blood vessels leading to your lungs from your heart. This allows blood to flow better in the lungs, which lowers blood pressure in the lungs, helps your body get more oxygen, and helps the heart work more efficiently.

Are you looking for information on Tyvaso (treprostinil) inhalation solution or treprostinil (Remodulin) injection instead?

Drug Facts

Common BrandsOrenitram

Drug ClassProstacyclin

Controlled Substance ClassificationNot a controlled medication

Generic StatusNo lower-cost generic available

AvailabilityPrescription only

What are the side effects of Orenitram (treprostinil)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Headache (63-75%)
Diarrhea (30-69%)
Nausea (30-40%)
Vomiting (17-36%)
Flushing (reddening of your skin, 15-45%)
Jaw pain (11-18%)

Other Side Effects

Pain in the arms or legs
Stomach pain
Bleeding

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

Allergic reaction

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

Diarrhea
Facial flushing, redness
Headache
Nausea
Swelling of the ankles, hands, or feet

Pros and cons of Orenitram (treprostinil)

Pros

Convenient tablet version compared to the treprostinil (Remodulin) injection and the Tyvaso (treprostinil) inhalation

Okay to use if you have kidney problems

Cons

Can't be used if you have severe liver problems

Can be burdensome, because you have to take it either two or three times a day; some alternatives like tadalafil (Adcirca) are only taken once daily

Only available as a brand medication, so it can be expensive

Pharmacist tips for Orenitram (treprostinil)

Orenitram (treprostinil) has a tablet shell that doesn't get dissolved in your stool. Don't be alarmed if you see it in your stool.

Take Orenitram (treprostinil) with food, and don't chew, crush, split, or break it.

If you miss a dose and it's too close to your normal dose time, skip it, and take the next one at your normal time.

Keep Orenitram (treprostinil) in a safe place at room temperature.

Let your healthcare provider know if you develop any muscle cramps, heartbeats, or weakness that's not normal.

Frequently asked questions about Orenitram (treprostinil)

What is pulmonary arterial hypertension (PAH)?

Pulmonary arterial hypertension (PAH) is when the arteries that carry blood from your heart to your lungs (pulmonary arteries) become more narrow. When these become narrower, your heart has to work harder to pump blood into your lungs. Also, the pulmonary arteries develop a higher pressure inside of them, because the heart is pumping harder against narrower arteries.

What are symptoms of PAH?

The most common symptoms of PAH include tiredness and shortness of breath or difficulty breathing, especially when doing daily activities (e.g., walking outside, going to mailbox, getting dressed). Other signs or symptoms are swelling in your feet, ankles, or stomach area, dizziness, and chest pain.

Why do I see my medication in my stool?

It's normal to see part of the tablet in your stool. Orenitram (treprostinil) is an extended-release tablet that has a special coating. This coating doesn't dissolve in your stomach or body, so it comes out in your stool. There is no harm in having this in your stool.

If I was taking the treprostinil (Remodulin) injection and I'm switching over to the Orenitram (treprostinil) tablet, should I stop treprostinil (Remodulin) immediately?

No, if you're switching from using the treprostinil (Remodulin) to the Orenitram (treprostinil) tablet, your healthcare provider will slowly lower your dose of treprostinil (Remodulin) over time while you are taking the Orenitram (treprostinil) tablets. Don't make any sudden changes to these medications without your healthcare provider's supervision.

Can I become pregnant while taking Orenitram (treprostinil)?

Let your healthcare provider know if you are planning to become pregnant, because PAH itself can pose some risks and challenges in pregnant women. There isn't a lot of data about Orenitram (treprostinil) use in pregnant women, so this might not be the best option for you. It's important to discuss these plans very clearly with your healthcare provider.

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What are the risks and warnings for Orenitram (treprostinil)?

Orenitram (treprostinil) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Worsening of PAH symptoms

Your symptoms of PAH can worsen if you lower your dose or stop taking Orenitram (treprostinil) suddenly. Don't lower your dose or stop taking the medication without talking to your provider first, so they can instruct you how to do this safely.

Caution in diverticulosis (problems with your gut)

Risk factors: Diverticulosis

The tablet shell of Orenitram (treprostinil) doesn't dissolve, and you'll see it in your stool. If you have a condition known as diverticulosis or any conditions that cause gut blockages, the tablet shell can get lodged in your gut. Let your healthcare provider know if you have problems with your gut before starting Orenitram (treprostinil).