6 Tyvaso Interactions to Consider
Key takeaways:
Tyvaso (treprostinil) is an inhaled medication that helps treat pulmonary hypertension symptoms. Medications such as gemfibrozil (Lopid) or rifampin (Rifadin) may change Tyvaso levels in the body, increasing your risk of side effects or making it less effective.
Tyvaso can lower your blood pressure. If you take other medications that lower blood pressure, there’s a risk that your blood pressure could drop too low. Your prescriber may OK this combination in some cases. But let them know if you feel dizzy or faint when using Tyvaso.
Tyvaso can also raise the risk of bleeding, especially if you also take blood thinners or nonsteroidal anti-inflammatory drugs. Don’t combine Tyvaso with these medications unless your prescriber OKs it. And keep an eye out for any signs or symptoms of bleeding.
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Table of contents
Pulmonary hypertension (high blood pressure in the lungs) can make it hard to breathe, especially when you’re exercising. Tyvaso (treprostinil) is a medication that helps widen the blood vessels in your lungs. This helps make exercising easier.
Tyvaso comes in a dry powder inhaler (DPI) and a solution that’s inhaled through a nebulizer machine. Since it’s inhaled directly into the lungs, Tyvaso doesn’t enter the bloodstream as much as oral medications. So it has fewer drug interactions than oral medications. But there are still a few that are helpful to keep in mind.
In this article, we will talk about six Tyvaso interactions to be aware of.
1. Gemfibrozil
Gemfibrozil (Lopid) is a medication used to lower high triglyceride and cholesterol levels. Gemfibrozil may raise Tyvaso levels in the body. This can raise the risk of Tyvaso side effects, such as cough and headache. Other medications may also have this effect, so be sure to review your medication list with your prescriber or pharmacist.
Since Tyvaso is inhaled, it’s unclear how much of an effect this interaction may actually have. Your prescriber may prefer a different cholesterol medication to avoid it. Or they may just keep an eye out for any increase in side effects when combining gemfibrozil and Tyvaso. In this case, be sure to let them know if you notice a change in how you’re tolerating Tyvaso treatments.
Medications for pulmonary arterial hypertension: Learn more about the different medications for PAH and how they compare.
Tyvaso side effects: Here’s what to expect when using Tyvaso and how to manage side effects if they occur.
How does Tyvaso work? Read a pharmacist’s answers to this and more Tyvaso FAQs.
2. Rifampin
Rifampin (Rifadin) is an antibiotic most often used to treat tuberculosis. Rifampin can lower Tyvaso levels in the body, making it less effective. Other medications, such as phenobarbital and phenytoin, can also cause this interaction.
As with gemfibrozil, it’s unclear if this interaction affects inhaled medication levels. Your prescriber may choose a different antibiotic that doesn’t interact with Tyvaso. Or they may raise your Tyvaso dosage if it seems less effective while you’re taking rifampin. Be sure to let them know if you notice any changes in your pulmonary hypertension symptoms while taking rifampin.
3. Medications that lower blood pressure
Tyvaso widens the blood vessels in your lungs. This helps make it easier to breathe when you exercise. But widening blood vessels can also lower your blood pressure. And if you’re taking other medications that lower your blood pressure, there’s an increased chance your blood pressure could drop too low.
Other medications that can lower blood pressure include:
Diuretics, such as hydrochlorothiazide (Microzide) and furosemide (Lasix)
Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Zestril, Qbrelis)
Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar)
Calcium channel blockers, such as amlodipine (Norvasc)
Beta blockers, such as metoprolol (Lopressor, Toprol XL)
Some of these medications are often prescribed as part of your overall pulmonary hypertension treatment. In this case, your prescriber will likely have you keep a close eye on your blood pressure. Be sure to let them know if you experience symptoms of low blood pressure while using Tyvaso, such as:
Lightheadedness
Dizziness
Blurry vision
Fainting
Your prescriber may need to adjust the dosage of your medications if you’re experiencing low blood pressure frequently while using Tyvaso.
4. Nitroglycerin
Nitroglycerin (Nitrostat) is a medication used to treat chest pain (angina). It widens the blood vessels to increase blood flow to the heart.
Since nitroglycerin and Tyvaso can both widen your blood vessels, combining these medications can also cause your blood pressure to drop lower than it should.
Nitroglycerin is often taken only as needed, so your prescriber may OK having prescriptions for both nitroglycerin and Tyvaso. But they’ll likely tell you not to use these medications at the same time. Talk to your prescriber for guidance if you’re taking both of these medications.
5. Blood thinners
Tyvaso may stop the platelets in your blood from sticking together to form blood clots. This means Tyvaso may raise your risk of bleeding, especially if you’re taking other blood thinner medications. This includes anticoagulants and antiplatelet medications, such as:
Warfarin (Coumadin, Jantoven)
Apixaban (Eliquis)
Rivaroxaban (Xarelto)
Clopidogrel (Plavix)
This interaction may be less of a risk with inhaled treprostinil than with oral or injectable forms of the medication. But you should still let your prescriber know if you’re taking a blood thinner before you start using Tyvaso. And let them know if minor bleeding signs appear, such as bleeding when brushing your teeth or frequent nosebleeds. Seek emergency care if you notice blood in your urine or stool or are vomiting or coughing up blood.
6. NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are common over-the-counter medications for pain or fever. But NSAIDs can also raise your risk of bleeding. Common NSAIDs include:
Aspirin (Bayer, Ecotrin)
Ibuprofen (Advil, Motrin)
Naproxen (Aleve, Naprosyn)
It’s best to get your prescriber’s OK before taking an NSAID. They can let you know if it’s a safe option or suggest an alternative treatment if needed.
Can you use Tyvaso if you’re taking bosentan or sildenafil?
Yes, bosentan (Tracleer) and sildenafil (Revatio) are other medications that are commonly prescribed for pulmonary hypertension. Tyvaso doesn’t interact with these medications. So you can take Tyvaso with either of these medications if your prescriber recommends it.
The bottom line
Tyvaso (treprostinil) is an inhaled medication that helps treat pulmonary hypertension symptoms. Medications like gemfibrozil (Lopid) can raise Tyvaso levels in the body. While medication like rifampin (Rifadin) can lower Tyvaso levels, your prescriber may still prescribe Tyvaso with these medications. But they’ll likely have you keep an eye on your pulmonary hypertension symptoms and report any Tyvaso side effects that occur.
Combining Tyvaso with medications that lower your blood pressure or widen your blood vessels can raise the chance that your blood pressure will drop too low. This includes beta blockers, calcium channel blockers, and diuretics. Your prescriber may still prescribe these medications if you’re using Tyvaso. But they’ll likely keep an eye on your blood pressure and adjust your dose if it drops too low.
Tyvaso may increase your bleeding risk. So it’s best to avoid taking blood thinners or nonsteroidal anti-inflammatory drugs with Tyvaso unless your prescriber OKs it.
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References
Ajimura, C. M., et al. (2018). Drug interactions with oral inhaled medications. Journal of Pharmacy Technology.
Canadian Agency for Drugs and Technologies in Health. (n.d.). Drugs for pulmonary arterial hypertension. CADTH Report.
Kumar, P., et al. (2016). A comprehensive review of treprostinil pharmacokinetics via four routes of administration. Clinical Pharmacokinetics.
National Heart, Lung, and Blood Institute. (2022). Low blood pressure.
National Heart, Lung, and Blood Institute. (2023). What is pulmonary hypertension?
Pulmonary Hypertension Association. (n.d.). Treatments.
RugBank Online. (n.d.). Cytochrome P-450 CYP2C8 Inhibitors (strong).
United Therapeutics Corporation. (2023). Tyvaso – treprostinil inhalant [package insert].
United Therapeutics Corporation. (2024). Tyvaso DPI - treprostinil inhalant [package insert].
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