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      text: "Wirkstoff: Treprostinil (als Natrium-Treprostinil)"
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      text: "Hilfsstoffe: Natriumcitrat, Natriumchlorid, Wasser f\xC3\xBCr Injektionszwecke, Metakresol 3 mg/ml (Konservans)"
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contra_indications: !ruby/object:ODDB::Text::Chapter 
  heading: Kontraindikationen
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      text: "\xC3\x9Cberempfindlichkeit gegen\xC3\xBCber einem Inhaltsstoff von Remodulin oder gegen\xC3\xBCber strukturverwandten Stoffen von Treprostinil."
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date: !ruby/object:ODDB::Text::Chapter 
  heading: Stand der Information
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      text: September 2015
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      text: "Dosierungshilfe f\xC3\xBCr die s.c. Applikation"
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      text: (Berechnungsformel siehe Dosierung/Anwendung)
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            raw_txt: "Subkutane Infusionsrate (ml/h) f\xC3\xBCr Remodulin 1 mg/ml"
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            raw_txt: Dosis (ng/kg/min)
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      text: Remodulin ist ein synthetisches Prostazyklin.
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      text: Vials mit 1 mg Treprostinil/ml; 2.5 mg Treprostinil/ml; 5 mg Treprostinil/ml; 10 mg Treprostinil/ml
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      text: Die gleichzeitige Anwendung von Diuretika, Antihypertensiva oder anderen Vasodilatatoren kann eine weitere Senkung des Blutdrucks verursachen.
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      text: "Wenn gleichzeitig andere Thrombozyten-Aggregationshemmer oder Antikoagulantien verabreicht werden, kann Remodulin das Risiko einer Blutung erh\xC3\xB6hen."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3073 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3073
      preformatted: false
      raw_txt: 
      text: "In klinischen Studien traten bei Patienten mit folgenden Arzneimitteln keine problematischen klinischen Manifestationen w\xC3\xA4hrend der Behandlung mit Remodulin auf: Antikoagulantien, Diuretika, Herzglykoside, Calciumantagonisten, Analgetika, Antipyretika, nichtsteroidale Antiphlogistika, Kortikosteroide und andere. Wie bei anderen Prostaglandin-Analoga kann Remodulin die thrombolytische Wirkung des Gewebeplasminogen-Aktivators (t-PA) durch die Erh\xC3\xB6hung der hepatischen Clearance von t-PA verringern."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3074 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3074
      preformatted: false
      raw_txt: 
      text: "Interaktionsstudien wurden mit Acetaminophen (4 g/Tag) und Warfarin (25 mg/Tag) bei gesunden Probanden durchgef\xC3\xBChrt. Acetaminophen zeigte keine klinisch signifikanten Wirkungen auf die Pharmakokinetik von Treprostinil. Es wurden weder erkennbare pharmakodynamische noch pharmakokinetische Interaktionen zwischen Remodulin und Warfarin festgestellt. Aufgrund von in-vitro-Untersuchungen mit Lebermikrosomen sind auch keine Interaktionen mit Phenprocoumon zu erwarten."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3075 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3075
      preformatted: false
      raw_txt: 
      text: "Bei Patienten, die Furosemid erhielten, war die Plasma-Clearance reduziert. M\xC3\xB6glicherweise besteht eine Interaktion zwischen Treprostinil und Furosemid, da beide Substanzen w\xC3\xA4hrend der Metabolisierung an der Carboxylat-Gruppe glukuronisiert werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3076 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 51
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 40
        start: 0
        values: 
        - :italic
      - !ruby/object:ODDB::Text::Format 
        end: 50
        start: 41
        values: 
        - :italic
      - *id3076
      preformatted: false
      raw_txt: 
      text: Cytochrom-P450-(CYP2C8)-Enzyminduktoren/inhibitoren
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3077 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 11
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 10
        start: 0
        values: 
        - :italic
      - *id3077
      preformatted: false
      raw_txt: 
      text: "Gemfibrozil: Pharmakokinetische Studien am Menschen mit oralem Treprostinil Diolamin zeigen, dass die gleichzeitige Verabreichung des Cytochrom-P450-(CYP2C8)-Enzyminhibitors Gemfibrozil die Exposition (sowohl Cmax als auch AUC) gegen\xC3\xBCber Treprostinil verdoppelt. Es wurde nicht festgestellt, ob die Sicherheit und Wirksamkeit von Remodulin \xC3\xBCber den parenteralen (subkutanen oder intraven\xC3\xB6sen) Verabreichungsweg durch CYP2C8-Inhibitoren ver\xC3\xA4ndert werden. Wird ein CYP2C8-Inhibitor (z. B. Gemfibrozil, Trimethoprim und Deferasirox) im Anschluss an die Titrierungsphase zur Medikation des Patienten hinzugenommen bzw. weggelassen, ist eine Dosisanpassung von Treprostinil in Betracht zu ziehen."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3078 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 10
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 9
        start: 0
        values: 
        - :italic
      - *id3078
      preformatted: false
      raw_txt: 
      text: "Rifampicin: Pharmakokinetische Studien am Menschen mit oralem Treprostinil Diolamin deuteten darauf hin, dass die gleichzeitige Verabreichung des CYP2C8-Enzyminduktors Rifampicin zu einer (um etwa 20-30 %) verminderten Exposition gegen\xC3\xBCber Treprostinil f\xC3\xBChrt. Es wurde nicht festgestellt, ob die Sicherheit und Wirksamkeit von Remodulin \xC3\xBCber den parenteralen (subkutanen oder intraven\xC3\xB6sen) Verabreichungsweg durch Rifampicin ver\xC3\xA4ndert werden. Wird Rifampicin im Anschluss an die Titrierungsphase zur Medikation des Patienten hinzugenommen bzw. weggelassen, ist eine Dosisanpassung von Treprostinil in Betracht zu ziehen."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3079 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 82
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 23
        start: 0
        values: 
        - :italic
      - !ruby/object:ODDB::Text::Format 
        end: 33
        start: 24
        values: 
        - :italic
      - !ruby/object:ODDB::Text::Format 
        end: 34
        start: 34
        values: 
        - :italic
      - !ruby/object:ODDB::Text::Format 
        end: 47
        start: 35
        values: 
        - :italic
      - !ruby/object:ODDB::Text::Format 
        end: 48
        start: 48
        values: 
        - :italic
      - !ruby/object:ODDB::Text::Format 
        end: 62
        start: 49
        values: 
        - :italic
      - !ruby/object:ODDB::Text::Format 
        end: 81
        start: 63
        values: 
        - :italic
      - *id3079
      preformatted: false
      raw_txt: 
      text: "CYP2C8-Induktoren (z. B. Phenytoin, Carbamazepin, Phenobarbital und Johanniskraut) k\xC3\xB6nnen zu einer verminderten Exposition gegen\xC3\xBCber Treprostinil f\xC3\xBChren. Wird ein CYP2C8-Induktor im Anschluss an die Titrierungsphase zur Medikation des Patienten hinzugenommen bzw. weggelassen, ist eine Dosisanpassung von Treprostinil in Betracht zu ziehen."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3080 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 8
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 7
        start: 0
        values: 
        - :italic
      - *id3080
      preformatted: false
      raw_txt: 
      text: Bosentan
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3081 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3081
      preformatted: false
      raw_txt: 
      text: "In einer pharmakokinetischen Studie am Menschen, bei der Bosentan (250 mg/Tag) und Treprostinil Diolamin (orale Dosis 2 mg/Tag) verabreicht wurden, waren keine pharmakokinetischen Wechselwirkungen zwischen Treprostinil und Bosentan zu beobachten. Es wurde nicht festgestellt, ob die Sicherheit und Wirksamkeit von Remodulin \xC3\xBCber den parenteralen (subkutanen oder intraven\xC3\xB6sen) Verabreichungsweg durch Rifampicin ver\xC3\xA4ndert werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3082 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 10
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 9
        start: 0
        values: 
        - :italic
      - *id3082
      preformatted: false
      raw_txt: 
      text: Sildenafil
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3083 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3083
      preformatted: false
      raw_txt: 
      text: "In einer pharmakokinetischen Studie am Menschen, bei der Sildenafil (60 mg/Tag) und Treprostinil Diolamin (orale Dosis 2 mg/Tag) verabreicht wurden, waren keine pharmakokinetischen Wechselwirkungen zwischen Treprostinil und Sildenafil zu beobachten. Es wurde nicht festgestellt, ob die Sicherheit und Wirksamkeit von Remodulin \xC3\xBCber den parenteralen (subkutanen oder intraven\xC3\xB6sen) Verabreichungsweg durch Rifampicin ver\xC3\xA4ndert werden."
    subheading: ""
kinetic: !ruby/object:ODDB::Text::Chapter 
  heading: Pharmakokinetik
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3084 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 10
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 9
        start: 0
        values: 
        - :italic
      - *id3084
      preformatted: false
      raw_txt: 
      text: Absorption
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3085 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3085
      preformatted: false
      raw_txt: 
      text: "Wird Remodulin subkutan infundiert, werden die Steady-State-Plasmakonzentrationen normalerweise 15 bis 18 Stunden nach Beginn der Therapie erreicht und sind bei Infusionsraten von 2.5 bis 125 ng/kg/min proportional zur Dosis. Remodulin wird als subkutane Infusion vollst\xC3\xA4ndig resorbiert."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3086 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 12
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 11
        start: 0
        values: 
        - :italic
      - *id3086
      preformatted: false
      raw_txt: 
      text: Distribution
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3087 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3087
      preformatted: false
      raw_txt: 
      text: "Bei gesunden Probanden erreichten die Plasmakonzentrationen nach subkutaner Verabreichung um 1 Uhr nachts und um 10 Uhr morgens ein Maximum sowie um 7 Uhr morgens und 4 Uhr nachmittags ein Minimum. Die Maxima lagen etwa 20 bis 30% h\xC3\xB6her als die Minima. Eine Dosisanpassung aufgrund der Tagesschwankungen wird nicht als n\xC3\xB6tig erachtet."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3088 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3088
      preformatted: false
      raw_txt: 
      text: "Das mittlere Verteilungsvolumen liegt bei 1.1 l/kg und die Plasma-Clearance bei 589 ml/kg/h. Die subkutane und intraven\xC3\xB6se Verabreichung von Remodulin zeigte eine Bio\xC3\xA4quivalenz im Steady state in einer Dosis von 10 ng/kg/min."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3089 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 12
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 11
        start: 0
        values: 
        - :italic
      - *id3089
      preformatted: false
      raw_txt: 
      text: Metabolismus
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3090 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3090
      preformatted: false
      raw_txt: 
      text: "Remodulin wird zu einem grossen Teil hepatisch metabolisiert. An der Metabolisierung von Treprostinil ist haupts\xC3\xA4chlich CYP2C8 und zu einem geringen Anteil CYP2C9 beteiligt. Auf Grund von in vitro-Daten mit humanen P450 hemmt Remodulin CYP1A2, 2C9, 2C19, 2D6, 2E1 und 3A nicht. Ob Remodulin P450 Isoenzyme induziert, ist derzeit am Menschen nicht untersucht."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3091 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3091
      preformatted: false
      raw_txt: 
      text: "Es wurde kein einzelner Hauptmetabolit von Treprostinil beobachtet. Im Urin wurden 5 Metaboliten in einer Menge von 10 bis 15% der verabreichten Dosis gefunden, insgesamt 64%. 3 der Metaboliten sind Oxidationsprodukte der 3-Hydroxyloctyl-Seitenkette, einer ist ein Glucuronid-Konjugat und einer ist nicht identifiziert. Nur 3.7% wurden unver\xC3\xA4ndert im Urin gefunden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3092 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 11
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 10
        start: 0
        values: 
        - :italic
      - *id3092
      preformatted: false
      raw_txt: 
      text: Elimination
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3093 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3093
      preformatted: false
      raw_txt: 
      text: "Bei subkutaner Applikation zeigt Treprostinil eine scheinbare Eliminationshalbwertszeit von 1.3 h verglichen mit 45 min bei intraven\xC3\xB6ser Verabreichung."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3094 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3094
      preformatted: false
      raw_txt: 
      text: "In einer Studie bei gesunden Probanden mit 14C-Treprostinil wurden \xC3\xBCber einen Zeitraum von 224 h 78.6% der verabreichten Dosis im Urin und 13.4% in den Faeces gefunden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3095 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 44
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 43
        start: 0
        values: 
        - :italic
      - *id3095
      preformatted: false
      raw_txt: 
      text: Kinetik in besonderen klinischen Situationen
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3096 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3096
      preformatted: false
      raw_txt: 
      text: "Kinder und Jugendliche: Es wurden keine Studien bei Kindern und Jugendlichen durchgef\xC3\xBChrt, weshalb die Anwendung nicht empfohlen wird."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3097 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3097
      preformatted: false
      raw_txt: 
      text: "\xC3\x84ltere Patienten: Bei \xC3\xA4lteren Patienten wurde eine geringe Reduktion der Steady-State-Clearance (ca. 3%) festgestellt, welche jedoch kaum eine Dosisanpassung rechtfertigt."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3098 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3098
      preformatted: false
      raw_txt: 
      text: "Leberfunktion: Die Plasma-Clearance war bei Patienten mit leichter bis mittlerer Leberfunktionsst\xC3\xB6rung (Pugh A,B) um 61 bis 80% reduziert verglichen mit gesunden Probanden, w\xC3\xA4hrend die Halbwertszeit unver\xC3\xA4ndert blieb. Aufgrund dieser Resultate sollte bei diesen Patienten die Initialdosis verabreicht sowie Dosisanpassungen mit Vorsicht vorgenommen werden. In Patienten mit schwerer Leberst\xC3\xB6rung liegen keine Erfahrungen vor (siehe Dosierung/Anwendung und Warnhinweise und Vorsichtsmassnahmen)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3099 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3099
      preformatted: false
      raw_txt: 
      text: "Nierenfunktionsst\xC3\xB6rungen: Es liegen keine speziellen Studien vor. Eine multivariante Analyse zeigte, dass die Plasma-Clearance von Treprostinil mit dem Serum-Kreatinin assoziiert ist."
    subheading: ""
name: !ruby/object:ODDB::Text::Chapter 
  heading: "Remodulin\xC2\xAE"
  sections: []

other_advice: !ruby/object:ODDB::Text::Chapter 
  heading: Sonstige Hinweise
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3100 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 18
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 17
        start: 0
        values: 
        - :italic
      - *id3100
      preformatted: false
      raw_txt: 
      text: "Inkompatibilit\xC3\xA4ten"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3101 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3101
      preformatted: false
      raw_txt: 
      text: Remodulin darf nicht mit anderen Arzneimitteln gemischt werden.
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3102 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 16
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 15
        start: 0
        values: 
        - :italic
      - *id3102
      preformatted: false
      raw_txt: 
      text: "Kompatibilit\xC3\xA4ten"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3103 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3103
      preformatted: false
      raw_txt: 
      text: "Wasser f\xC3\xBCr Injektionszwecke und 0.9% w\xC3\xA4ssrige NaCl-L\xC3\xB6sung"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3104 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 11
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 10
        start: 0
        values: 
        - :italic
      - *id3104
      preformatted: false
      raw_txt: 
      text: Haltbarkeit
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3105 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3105
      preformatted: false
      raw_txt: 
      text: "Unge\xC3\xB6ffnete Vials d\xC3\xBCrfen nur bis zu dem auf der Packung mit EXP bezeichneten Datum verwendet werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3106 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3106
      preformatted: false
      raw_txt: 
      text: "Einmal angestochene Vials d\xC3\xBCrfen h\xC3\xB6chstens w\xC3\xA4hrend 30 Tagen verwendet werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3107 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3107
      preformatted: false
      raw_txt: 
      text: "Die Kompatibilit\xC3\xA4t ist in einem Konzentrationsbereich von 0.004 mg/ml bis 0.13 mg/ml belegt."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3108 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 19
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 18
        start: 0
        values: 
        - :italic
      - *id3108
      preformatted: false
      raw_txt: 
      text: Subkutane Anwendung
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3109 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3109
      preformatted: false
      raw_txt: 
      text: "Das Infusionsbesteck (inkl. L\xC3\xB6sungsreservoir) ist alle 48 bis 72 h auszuwechseln."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3110 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 21
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 20
        start: 0
        values: 
        - :italic
      - *id3110
      preformatted: false
      raw_txt: 
      text: "Intraven\xC3\xB6se Anwendung"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3111 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3111
      preformatted: false
      raw_txt: 
      text: "Die verd\xC3\xBCnnte L\xC3\xB6sung muss zumindest alle 48 Stunden gewechselt werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3112 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 27
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 26
        start: 0
        values: 
        - :italic
      - *id3112
      preformatted: false
      raw_txt: 
      text: Besondere Lagerungshinweise
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3113 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3113
      preformatted: false
      raw_txt: 
      text: "Bei Raumtemperatur (15 bis 25 \xC2\xB0C) ausserhalb der Reichweite von Kindern lagern."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3114 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 27
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 26
        start: 0
        values: 
        - :italic
      - *id3114
      preformatted: false
      raw_txt: 
      text: "Hinweise f\xC3\xBCr die Handhabung"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3115 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3115
      preformatted: false
      raw_txt: 
      text: "Bez\xC3\xBCglich Anwendung der Pumpe vergleiche \xE2\x80\x9CDosierung/Anwendung\xE2\x80\x9C."
    subheading: ""
overdose: !ruby/object:ODDB::Text::Chapter 
  heading: "\xC3\x9Cberdosierung"
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3116 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3116
      preformatted: false
      raw_txt: 
      text: "Die Zeichen und Symptome der \xC3\x9Cberdosierung mit Remodulin w\xC3\xA4hrend der klinischen Studien sind \xC3\xA4hnlich den erwarteten dosis-limitierenden pharmakologischen Wirkungen von Remodulin, wie Fieberhitze, Kopfschmerzen, Hypotonie, \xC3\x9Cbelkeit, Erbrechen und Durchfall. Die meisten Ereignisse waren selbstlimitierend und verschwanden nach einer Dosisreduktion oder nach Abbruch der Behandlung. In vereinzelten F\xC3\xA4llen wurde auch eine Entgleisung der pulmonalen arteriellen Hypertonie beobachtet."
    subheading: ""
packages: !ruby/object:ODDB::Text::Chapter 
  heading: Packungen
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3117 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3117
      preformatted: false
      raw_txt: 
      text: "Remodulin Infusionsl\xC3\xB6sung 1 mg/ml Vial 20 ml (B)"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3118 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3118
      preformatted: false
      raw_txt: 
      text: "Remodulin Infusionsl\xC3\xB6sung 2.5 mg/ml Vial 20 ml (B)"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3119 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3119
      preformatted: false
      raw_txt: 
      text: "Remodulin Infusionsl\xC3\xB6sung 5 mg/ml Vial 20 ml (B)"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3120 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3120
      preformatted: false
      raw_txt: 
      text: "Remodulin Infusionsl\xC3\xB6sung 10 mg/ml Vial 20 ml (B)"
    subheading: ""
preclinic: !ruby/object:ODDB::Text::Chapter 
  heading: "Pr\xC3\xA4klinische Daten"
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3121 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 132
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 110
        start: 0
        values: []

      - !ruby/object:ODDB::Text::Format 
        end: 119
        start: 111
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        - :italic
      - !ruby/object:ODDB::Text::Format 
        end: 123
        start: 120
        values: []

      - !ruby/object:ODDB::Text::Format 
        end: 131
        start: 124
        values: 
        - :italic
      - *id3121
      preformatted: false
      raw_txt: 
      text: "Es wurden keine Langzeitstudien durchgef\xC3\xBChrt, um die karzinogene Wirkung zu bewerten. Aus den Mutagenit\xC3\xA4tstests in vitro und in vivo ging weder eine mutagene noch eine klastogene Wirkung von Treprostinil hervor. In Ratten wurden bei Dosen bis zu 900 ng/kg/min und in Kaninchen bis 50 ng/kg/min keine reproduktionstoxikologischen Effekte beobachtet. In Kaninchen fand man bei Dosen von 150 und 300 ng/kg/min und unter maternaler Toxizit\xC3\xA4t eine erh\xC3\xB6hte Zahl von Skelettvariationen. Die m\xC3\xA4nnliche und die weibliche Reproduktionsf\xC3\xA4higkeit war in Ratten bei Dosen bis 450 ng/kg/min nicht beeinflusst."
    - !ruby/object:ODDB::Text::Paragraph 
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        end: -1
        start: 0
        values: []

      formats: 
      - *id3122
      preformatted: false
      raw_txt: 
      text: "In Studien an Ratten und Kaninchen, die \xC3\xBCber 26 Wochen durchgef\xC3\xBChrt worden waren, erwies sich Treprostinil in der Dosierung von 450 ng/kg/Min. bzw. 200 ng/kg/Min. als nicht toxisch."
    subheading: ""
pregnancy: !ruby/object:ODDB::Text::Chapter 
  heading: Schwangerschaft/Stillzeit
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3123 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3123
      preformatted: false
      raw_txt: 
      text: "In Kaninchen fand man in den F\xC3\xB6ten unter maternaler Toxizit\xC3\xA4t (bei Dosen von 150 und 300 ng/kg/min) eine erh\xC3\xB6hte Zahl von Skelettvariationen. Sonst wurden keine adversen Effekte in reproduktionstoxikologischen Studien festgestellt."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3124 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3124
      preformatted: false
      raw_txt: 
      text: "Es liegen keine Studien bei schwangeren Frauen vor. Remodulin sollte w\xC3\xA4hrend der Schwangerschaft nur angewendet werden, wenn es unbedingt notwendig ist."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3125 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3125
      preformatted: false
      raw_txt: 
      text: "Es ist nicht bekannt, ob Treprostinil in die Muttermilch ausgeschieden und vom Kind systemisch aufgenommen wird. Daher sollte w\xC3\xA4hrend der Stillzeit Remodulin nicht angewendet werden."
    subheading: ""
reference: 
registration_owner: !ruby/object:ODDB::Text::Chapter 
  heading: Zulassungsinhaberin
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3126 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
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      formats: 
      - *id3126
      preformatted: false
      raw_txt: 
      text: "OrPha Swiss GmbH, 8700 K\xC3\xBCsnacht"
    subheading: ""
restrictions: !ruby/object:ODDB::Text::Chapter 
  heading: Warnhinweise und Vorsichtsmassnahmen
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3127 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3127
      preformatted: false
      raw_txt: 
      text: "Remodulin sollte nur von Spezial\xC3\xA4rzten mit Erfahrung in der Diagnose und Behandlung von pulmonaler arterieller Hypertonie eingesetzt werden. Die Entscheidung zum Therapiebeginn mit Remodulin sollte im Wissen erfolgen, dass die Therapie mit grosser Wahrscheinlichkeit \xC3\xBCber lange Zeit, m\xC3\xB6glicherweise \xC3\xBCber Jahre durchgef\xC3\xBChrt werden muss. Die F\xC3\xA4higkeit des Patienten, Remodulin zu applizieren und das Infusionssystem zu pflegen, sollte ber\xC3\xBCcksichtigt werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3128 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3128
      preformatted: false
      raw_txt: 
      text: "Remodulin sollte nur subkutan oder in verd\xC3\xBCnnter Form intraven\xC3\xB6s verabreicht werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3129 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3129
      preformatted: false
      raw_txt: 
      text: "Remodulin ist ein stark wirkender pulmonaler und systemischer Vasodilatator. Die Behandlung mit Remodulin muss daher mit entsprechend ausgebildetem Personal und einer Ausr\xC3\xBCstung f\xC3\xBCr eine physiologische \xC3\x9Cberwachung und Notfallbehandlung begonnen werden. Die Dosisanpassungen wurden in den klinischen Studien aufgrund der Symptome der pulmonalen arteriellen Hypertonie und der Nebenwirkungen von Remodulin vorgenommen."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3130 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3130
      preformatted: false
      raw_txt: 
      text: "Bei Patienten, die Remodulin mittels intraven\xC3\xB6ser Infusion erhalten haben, wurde \xC3\xBCber Zentralvenenkatheterassozierte Bakteri\xC3\xA4mien und Sepsis berichtet. Diese Risiken h\xC3\xA4ngen mit dem Verabreichungssystem zusammen. \xC3\x84rzte sollten ber\xC3\xBCcksichtigen, dass Patienten mit Langzeit-Zentralvenenkatheter mit Gram-negativen und Gram-positiven Keimen infizieren k\xC3\xB6nnen. Die Verwendung eines 0.2 Mikrometer inline Filters wird empfohlen, um das Risiko einer systemischen Infektion als Folge einer Verunreinigung in der Zubereitung des Medikamentes zu minimieren."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3131 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3131
      preformatted: false
      raw_txt: 
      text: "Wie mit jedem stark wirksamen Vasodilatator kann ein pl\xC3\xB6tzlicher Therapieabbruch oder ein starke Reduktion der Dosierung eine Verschlechterung der pulmonalen arteriellen Hypertonie bewirken."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3132 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3132
      preformatted: false
      raw_txt: 
      text: "Die gleichzeitige Verabreichung eines Cytochrom-P450-(CYP2C8)-Enzyminhibitors (z. B. Gemfibrozil) kann zu einer erh\xC3\xB6hten Exposition (sowohl Cmax als auch AUC) gegen\xC3\xBCber Treprostinil f\xC3\xBChren. Bei einer erh\xC3\xB6hten Exposition besteht die Wahrscheinlichkeit eines verst\xC3\xA4rkten Auftretens von unerw\xC3\xBCnschten Wirkungen in Verbindung mit der Verabreichung von Treprostinil. Daher ist eine Herabsetzung der Dosis in Betracht zu ziehen (siehe \xE2\x80\x9EInteraktionen\xE2\x80\x9C)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3133 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3133
      preformatted: false
      raw_txt: 
      text: "Die gleichzeitige Verabreichung eines CYP2C8-Enzyminduktors (z. B. Rifampicin) kann zu einer verminderten Exposition gegen\xC3\xBCber Treprostinil f\xC3\xBChren. Bei einer verminderten Exposition besteht die Wahrscheinlichkeit einer reduzierten klinischen Wirksamkeit. Daher ist eine h\xC3\xB6here Dosierung von Treprostinil in Betracht zu ziehen (siehe \xE2\x80\x9EInteraktionen\xE2\x80\x9C)."
    subheading: ""
unwanted_effects: !ruby/object:ODDB::Text::Chapter 
  heading: "Unerw\xC3\xBCnschte Wirkungen"
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3134 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
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      formats: 
      - *id3134
      preformatted: false
      raw_txt: 
      text: "Eine Interpretation der Nebenwirkungen ist dadurch erschwert, dass einzelne klinische Symptome der pulmonalen arteriellen Hypertonie (z.B. Schwindel, Ohnmacht) \xC3\xA4hnlich sind. Unerw\xC3\xBCnschte Wirkungen, die wahrscheinlich auf die zugrunde liegende Krankheit zur\xC3\xBCckzuf\xC3\xBChren sind, schliessen Atemnot, M\xC3\xBCdigkeit, Brustschmerzen, rechtsventrikul\xC3\xA4rer Herzschlag und Bl\xC3\xA4sse ein."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3135 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3135
      preformatted: false
      raw_txt: 
      text: "Einige unerw\xC3\xBCnschte Wirkungen k\xC3\xB6nnen eindeutig Remodulin zugeschrieben werden. Die h\xC3\xA4ufigsten bei der subkutanen Anwendung sind Reaktionen an der Infusionsstelle (83%) und Schmerzen an der Infusionsstelle (85%), welche aber von den meisten Patienten ertragen werden. Den Reaktionen an der Infusionsstelle wurden alle Ereignisse wie Erytheme, Verh\xC3\xA4rtungen, Hautausschlag usw. ausser Schmerzen oder Blutungen/blaue Flecken zugeordnet."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3136 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
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      formats: 
      - *id3136
      preformatted: false
      raw_txt: 
      text: "Die H\xC3\xA4ufigkeitsangaben sind wie folgt definiert: \xE2\x80\x9ESehr h\xC3\xA4ufig\xE2\x80\x9C (\xE2\x89\xA51/10), \xE2\x80\x9Eh\xC3\xA4ufig\xE2\x80\x9C (<1/10, \xE2\x89\xA51/100), \xE2\x80\x9Egelegentlich\xE2\x80\x9C (<1/100, \xE2\x89\xA51/1000), \xE2\x80\x9Eselten\xE2\x80\x9C (<1/1000, \xE2\x89\xA51/10\xE2\x80\x98000), \xE2\x80\x9Esehr selten\xE2\x80\x9C (<1/10\xE2\x80\x98000)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3137 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 21
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 20
        start: 0
        values: 
        - :italic
      - *id3137
      preformatted: false
      raw_txt: 
      text: Blut- und Lymphsystem
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3138 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 8
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 7
        start: 0
        values: 
        - :italic
      - *id3138
      preformatted: false
      raw_txt: 
      text: "H\xC3\xA4ufig : \xC3\x96deme."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3139 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 12
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 11
        start: 0
        values: 
        - :italic
      - *id3139
      preformatted: false
      raw_txt: 
      text: Nervensystem
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3140 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 13
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 12
        start: 0
        values: 
        - :italic
      - *id3140
      preformatted: false
      raw_txt: 
      text: "Sehr h\xC3\xA4ufig : Kopfschmerzen (30%)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3141 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 7
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 6
        start: 0
        values: 
        - :italic
      - *id3141
      preformatted: false
      raw_txt: 
      text: "Gef\xC3\xA4sse"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3142 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 7
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 6
        start: 0
        values: 
        - :italic
      - *id3142
      preformatted: false
      raw_txt: 
      text: "H\xC3\xA4ufig: Vasodilatation."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3143 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 27
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 26
        start: 0
        values: 
        - :italic
      - *id3143
      preformatted: false
      raw_txt: 
      text: "Gastrointestinale St\xC3\xB6rungen"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3144 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 12
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 11
        start: 0
        values: 
        - :italic
      - *id3144
      preformatted: false
      raw_txt: 
      text: "Sehr h\xC3\xA4ufig: Durchfall (22%), \xC3\x9Cbelkeit (19%)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3145 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 4
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 3
        start: 0
        values: 
        - :italic
      - *id3145
      preformatted: false
      raw_txt: 
      text: Haut
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3146 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 12
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 11
        start: 0
        values: 
        - :italic
      - *id3146
      preformatted: false
      raw_txt: 
      text: "Sehr h\xC3\xA4ufig: Hautausschlag (12%)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3147 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 19
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 18
        start: 0
        values: 
        - :italic
      - *id3147
      preformatted: false
      raw_txt: 
      text: Muskelskelettsystem
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3148 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 12
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 11
        start: 0
        values: 
        - :italic
      - *id3148
      preformatted: false
      raw_txt: 
      text: "Sehr h\xC3\xA4ufig: Kieferschmerzen (13%)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3149 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 9
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 8
        start: 0
        values: 
        - :italic
      - *id3149
      preformatted: false
      raw_txt: 
      text: Allgemein
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3150 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 7
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 6
        start: 0
        values: 
        - :italic
      - *id3150
      preformatted: false
      raw_txt: 
      text: "H\xC3\xA4ufig: Schmerzen."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3151 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 36
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 35
        start: 0
        values: 
        - :italic
      - *id3151
      preformatted: false
      raw_txt: 
      text: Reaktionen an der Applikationsstelle
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3152 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3152
      preformatted: false
      raw_txt: 
      text: "-Erytheme, Verh\xC3\xA4rtungen, Hautausschlag usw. (83%),"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3153 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3153
      preformatted: false
      raw_txt: 
      text: -Schmerzen an der Infusionsstelle (85%),
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3154 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3154
      preformatted: false
      raw_txt: 
      text: -Blutungen oder blaue Flecken an der Infusionsstelle (21%).
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3155 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 57
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 56
        start: 0
        values: 
        - :italic
      - *id3155
      preformatted: false
      raw_txt: 
      text: Ereignisse, die in der klinischen Praxis aufgetreten sind
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3156 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3156
      preformatted: false
      raw_txt: 
      text: "Zus\xC3\xA4tzlich zu den unerw\xC3\xBCnschten Reaktionen, die in klinischen Studien aufgetreten sind, wurden folgende Ereignisse bei der Anwendung von Remodulin nach Zulassung berichtet: Da diese freiwillig von einer Population von unbekannter Gr\xC3\xB6sse berichtet wurden, k\xC3\xB6nnen keine Einsch\xC3\xA4tzungen der H\xC3\xA4ufigkeit vorgenommen werden. Thrombophlebitis im Zusammenhang mit peripherer intraven\xC3\xB6ser Infusion, Infektion des Blutkreislaufs in Zusammenhang mit dem Zentralvenenkatheter, Sepsis, Bakteri\xC3\xA4mie, Infektion an der Infusionsstelle, Abszessbildung an der subkutanen Infusionsstelle, Thrombozytopenie, Blutungen im Bereich der Infusionsstelle und Knochenschmerzen."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3157 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3157
      preformatted: false
      raw_txt: 
      text: "Ausserdem wurde gelegentlich \xC3\xBCber generalisierte Hautausschl\xC3\xA4ge, die manchmal makul\xC3\xB6ser oder papul\xC3\xA4rer Natur waren, und Cellulitis berichtet."
    subheading: ""
usage: !ruby/object:ODDB::Text::Chapter 
  heading: Dosierung/Anwendung
  sections: 
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3158 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 12
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 11
        start: 0
        values: 
        - :italic
      - *id3158
      preformatted: false
      raw_txt: 
      text: Initialdosis
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3159 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3159
      preformatted: false
      raw_txt: 
      text: "Remodulin wird mittels subkutaner oder intraven\xC3\xB6ser Dauerinfusion verabreicht. Die Infusionsrate sollte zu Beginn bei 1.25 ng/kg/min liegen. Falls diese Dosierung vom Patienten nicht vertragen wird, kann die Infusionsrate auf 0.625 ng/kg/min gesenkt werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3160 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3160
      preformatted: false
      raw_txt: 
      text: "CAVE: Die intraven\xC3\xB6se Applikation darf nie unverd\xC3\xBCnnt erfolgen."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3161 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 16
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 15
        start: 0
        values: 
        - :italic
      - *id3161
      preformatted: false
      raw_txt: 
      text: Dosisanpassungen
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3162 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3162
      preformatted: false
      raw_txt: 
      text: "Das Ziel der chronischen Dosisanpassung ist, die Dosis zu finden, welche die Symptome der pulmonalen arteriellen Hypertonie verbessert, w\xC3\xA4hrend das Nebenwirkungsprofil ertr\xC3\xA4glich bleibt. In den ersten 4 Wochen sollte die Infusionsrate um 1.25 ng/kg/min pro Woche gesteigert werden und dann um 2.5 ng/kg/min pro Woche. Dosis-abh\xC3\xA4ngige unerw\xC3\xBCnschte Wirkungen k\xC3\xB6nnen eine Reduktion der Infusionsrate notwendig machen, wobei die Nebenwirkung m\xC3\xB6glicherweise auch ohne Dosisanpassung wieder verschwindet. Sollte eine Nebenwirkung schlimmer und/oder unertr\xC3\xA4glich werden, sollte die Infusionsrate gesenkt werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3163 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3163
      preformatted: false
      raw_txt: 
      text: "Ein pl\xC3\xB6tzlicher Therapieabbruch oder eine starke Reduktion der Dosierung ist zu vermeiden (siehe \xE2\x80\x9EWarnhinweise und Vorsichtsmassnahmen\xE2\x80\x9C)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3164 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3164
      preformatted: false
      raw_txt: 
      text: "In den meisten F\xC3\xA4llen kann nach einer Unterbrechung von wenigen Stunden die Infusion in derselben Dosisrate wieder begonnen werden. Bei einer l\xC3\xA4ngeren Unterbrechung ist m\xC3\xB6glicherweise eine Retitrierung der Dosis erforderlich."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3165 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3165
      preformatted: false
      raw_txt: 
      text: In Langzeitanwendungsstudien betrugen die nach 12 Monaten erreichten mittleren Dosisraten 26 ng/kg/min, nach 24 Monaten 36 ng/kg/min und nach 36 Monaten 42 ng/kg/min.
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3166 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 22
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 21
        start: 0
        values: 
        - :italic
      - *id3166
      preformatted: false
      raw_txt: 
      text: Kinder und Jugendliche
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3167 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3167
      preformatted: false
      raw_txt: 
      text: "Es liegen zu wenige Daten \xC3\xBCber Kinder und Jugendliche unter 16 Jahren vor, um zu entscheiden, ob die Erwachsenen-Dosierung bei dieser Patientengruppe angewendet werden kann."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3168 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 23
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 22
        start: 0
        values: 
        - :italic
      - *id3168
      preformatted: false
      raw_txt: 
      text: Subkutane Dauerinfusion
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3169 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3169
      preformatted: false
      raw_txt: 
      text: "Die subkutane Infusionsrate wird nach folgender Formel berechnet:"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3170 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3170
      preformatted: false
      raw_txt: 
      text: "Infusionsrate (ml/h):"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3171 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3171
      preformatted: false
      raw_txt: 
      text: "Dosis (ng/kg/min) \xC3\x97 Gewicht (kg) \xC3\x97 0.00006*"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3172 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3172
      preformatted: false
      raw_txt: 
      text: Remodulin-Konzentration (mg/ml)
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3173 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3173
      preformatted: false
      raw_txt: 
      text: "* Konversionsfaktor (0.00006): 60 min/h \xC3\x97 0.000001 mg/ng"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3174 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 25
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 24
        start: 0
        values: 
        - :italic
      - *id3174
      preformatted: false
      raw_txt: 
      text: "Intraven\xC3\xB6se Dauerinfusion"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3175 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3175
      preformatted: false
      raw_txt: 
      text: "Verd\xC3\xBCnntes Remodulin wird mittels intraven\xC3\xB6ser Dauerinfusion \xC3\xBCber einen Zentralvenenkatheter mittels einer Pumpe f\xC3\xBCr intraven\xC3\xB6se Applikation infundiert."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3176 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3176
      preformatted: false
      raw_txt: 
      text: "Es kann auch vor\xC3\xBCbergehend \xC3\xBCber eine periphere Venenkan\xC3\xBCle verabreicht werden, vorzugsweise in eine grosse Vene. Die Anwendung einer peripheren Infusion \xC3\xBCber mehr als einige Stunden kann das Risiko f\xC3\xBCr Thrombophlebitis erh\xC3\xB6hen (siehe \xE2\x80\x9EUnerw\xC3\xBCnschte Wirkungen\xE2\x80\x9C)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3177 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3177
      preformatted: false
      raw_txt: 
      text: Die Verwendung eines 0.2 Mikrometer inline Filters wird empfohlen, um das Risiko einer systemischen Infektion als Folge einer Verunreinigung in der Zubereitung des Medikamentes zu minimieren.
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3178 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3178
      preformatted: false
      raw_txt: 
      text: "Berechnung der Konzentration, die die verd\xC3\xBCnnte Remodulin-L\xC3\xB6sung haben muss:"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3179 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3179
      preformatted: false
      raw_txt: 
      text: "Endkonzentration der verd\xC3\xBCnnten Remodulin-L\xC3\xB6sung (mg/ml):"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3180 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3180
      preformatted: false
      raw_txt: 
      text: "Dosis (ng/kg/min) \xC3\x97 Gewicht (kg) \xC3\x97 0.00006"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3181 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3181
      preformatted: false
      raw_txt: 
      text: "intraven\xC3\xB6se Infusionsrate (ml/h)"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3182 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3182
      preformatted: false
      raw_txt: 
      text: "Berechnung der notwendigen Menge Remodulin, die mit ausreichend Verd\xC3\xBCnnungsmittel (steriles Wasser ad inject. oder 0.9% NaCl-L\xC3\xB6sung f\xC3\xBCr Infusionen) verd\xC3\xBCnnt werden muss:"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3183 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3183
      preformatted: false
      raw_txt: 
      text: "Volumen von zu verwendendem Remodulin (ml):"
    subheading: ""
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Table 
      rows: 
      - - !ruby/object:ODDB::Text::MultiCell 
          col_span: 1
          contents: 
          - !ruby/object:ODDB::Text::Paragraph 
            format: &id3184 !ruby/object:ODDB::Text::Format 
              end: -1
              start: 0
              values: []

            formats: 
            - *id3184
            preformatted: false
            raw_txt: "Endkonzentration der verd\xC3\xBCnnten Remodulin-L\xC3\xB6sung (mg/ml)Remodulin Konzentrationim Vial (mg/ml)"
            text: "Endkonzentration der verd\xC3\xBCnnten Remodulin-L\xC3\xB6sung (mg/ml)Remodulin Konzentrationim Vial (mg/ml)"
          row_span: 1
        - !ruby/object:ODDB::Text::MultiCell 
          col_span: 1
          contents: 
          - " "
          - !ruby/object:ODDB::Text::Paragraph 
            format: &id3185 !ruby/object:ODDB::Text::Format 
              end: -1
              start: 0
              values: []

            formats: 
            - *id3185
            preformatted: false
            raw_txt: "\xC3\x97 "
            text: "\xC3\x97"
          row_span: 1
        - !ruby/object:ODDB::Text::MultiCell 
          col_span: 1
          contents: 
          - !ruby/object:ODDB::Text::Paragraph 
            format: &id3186 !ruby/object:ODDB::Text::Format 
              end: -1
              start: 0
              values: []

            formats: 
            - *id3186
            preformatted: false
            raw_txt: Totales Volumen des Reservoirs der Pumpe (ml)
            text: Totales Volumen des Reservoirs der Pumpe (ml)
          row_span: 1
    subheading: ""
  - !ruby/object:ODDB::Text::Section 
    paragraphs: 
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3187 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3187
      preformatted: false
      raw_txt: 
      text: "Die berechnete Menge Remodulin wird in das Reservoir gegeben und mit gen\xC3\xBCgend sterilem Wasser oder 0.9% NaCl-L\xC3\xB6sung verd\xC3\xBCnnt."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3188 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 9
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 8
        start: 0
        values: 
        - :italic
      - *id3188
      preformatted: false
      raw_txt: 
      text: Anwendung
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3189 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3189
      preformatted: false
      raw_txt: 
      text: "Die Behandlung mit Remodulin wird im Spital unter \xC3\xA4rztlicher \xC3\x9Cberwachung begonnen. Remodulin wird als subkutane oder intraven\xC3\xB6se Dauerinfusion appliziert."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3190 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3190
      preformatted: false
      raw_txt: 
      text: "Bei der subkutanen Infusion wird die Kan\xC3\xBCle unter die Haut auf dem Bauch oder auf dem Oberschenkel platziert und befestigt. Das Remodulin Vial ist bei der subkutanen Applikation Teil der Pumpe. Das Infusionsbesteck und das entsprechende Arzneimittelreservoir muss alle 48 bis 72 Stunden gewechselt werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3191 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3191
      preformatted: false
      raw_txt: 
      text: "Bei der intraven\xC3\xB6sen Applikation wird ein zentraler Dauerkatheder gesetzt. Remodulin wird \xC3\xBCber eine kleine Pumpe, die am Gurt, an der Wade, am Oberschenkel oder Bauch befestigt wird, dauernd mit konstantem Fluss freigesetzt. F\xC3\xBCr die intraven\xC3\xB6se Applikation wird Remodulin verd\xC3\xBCnnt eingesetzt. Die L\xC3\xB6sung wird \xC3\xBCber einen feinen Polyvinyl-Schlauch zur Nadel transportiert."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3192 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3192
      preformatted: false
      raw_txt: 
      text: "Bei der intraven\xC3\xB6sen Infusion muss die verd\xC3\xBCnnte L\xC3\xB6sung (wegen der Stabilit\xC3\xA4t von Remodulin) zumindest alle 48 Stunden gewechselt werden."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3193 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3193
      preformatted: false
      raw_txt: 
      text: "Im Spital wird den Patienten bzw. Patientinnen vom Personal der Gebrauch der Pumpe, das Einsetzen des Infusionsbestecks, der Ersatz des Remodulin-Reservoirs und der Einsatz der Dauerinfusion genau erkl\xC3\xA4rt. Die hygienische Handhabung ist zu beachten."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3194 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3194
      preformatted: false
      raw_txt: 
      text: "Die Durchflussrate von Remodulin wird jede Woche neu eingestellt. Meistens wird die Dosierung in Abh\xC3\xA4ngigkeit der Symptome der pulmonalen Hypertonie leicht erh\xC3\xB6ht. Falls unertr\xC3\xA4gliche Nebenwirkungen auftreten, wird die Dosierung nach Anweisung des Arztes bzw. der \xC3\x84rztin angepasst."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3195 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3195
      preformatted: false
      raw_txt: 
      text: Die korrekte Handhabung der Infusionspumpe ist in der Gebrauchsanweisung der Pumpe beschrieben.
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3196 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3196
      preformatted: false
      raw_txt: 
      text: Es ist wichtig, dass die richtige Remodulin-Konzentration und das richtige Infusionsbesteck angewendet werden.
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3197 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3197
      preformatted: false
      raw_txt: 
      text: "Ein schlechtes Funktionieren der Pumpe oder eine Verstopfung des Infusionsbestecks k\xC3\xB6nnen zu einer Verschlechterung der Symptome der pulmonalen arteriellen Hypertonie f\xC3\xBChren. Im Falle eines Unterbruchs des Flusses von Remodulin sind die Anweisungen der Bedienungsanleitung der Pumpe einzuhalten. Der Patient bzw. die Patientin sollte immer eine Infusionspumpe, Infusionsbesteck und Remodulin in Reserve halten."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3198 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3198
      preformatted: false
      raw_txt: 
      text: "Die Infusionspumpe, mit der Remodulin appliziert wird, sollte folgende Anforderungen erf\xC3\xBCllen:"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3199 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3199
      preformatted: false
      raw_txt: 
      text: "\xE2\x80\x93 klein und leicht sein,"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3200 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3200
      preformatted: false
      raw_txt: 
      text: "\xE2\x80\x93 die Anpassung der Infusionsrate in Schritten von 0.002 ml/h f\xC3\xBCr die s.c Infusion sowie von ca. 0.05 ml/Std. f\xC3\xBCr die i.v. Infusion erlauben. Eine typische Infusionsrate f\xC3\xBCr i.v. Infusionspumpen l\xC3\xA4ge zwischen 0.4 und 2 ml pro Stunde."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3201 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3201
      preformatted: false
      raw_txt: 
      text: "\xE2\x80\x93 sollte Alarmfunktionen bei Verstopfung/fehlendem Fluss, schwacher Batterie, Programmfehler oder Motor-St\xC3\xB6rungen haben,"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3202 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3202
      preformatted: false
      raw_txt: 
      text: "\xE2\x80\x93 eine Fluss-Genauigkeit von \xC2\xB16% oder besser aufweisen,"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3203 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3203
      preformatted: false
      raw_txt: 
      text: "\xE2\x80\x93 mit positivem Druck betrieben werden,"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3204 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3204
      preformatted: false
      raw_txt: 
      text: "\xE2\x80\x93 das Reservoir sollte aus Polyvinylchlorid, Polypropylen oder Glas sein."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3205 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3205
      preformatted: false
      raw_txt: 
      text: "Remodulin ist in Konzentrationen von 1 mg/ml, 2,5 mg/ml, 5 mg/ml und 10 mg/ml erh\xC3\xA4ltlich."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3206 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3206
      preformatted: false
      raw_txt: 
      text: "Die Tabellen als Dosierungshilfen sind am Ende der Fachinformation aufgef\xC3\xBChrt."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3207 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 37
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 36
        start: 0
        values: 
        - :italic
      - *id3207
      preformatted: false
      raw_txt: 
      text: "Anwendung bei Leberfunktionsst\xC3\xB6rungen"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3208 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3208
      preformatted: false
      raw_txt: 
      text: "Milde bis moderate Leberfunktionsst\xC3\xB6rungen reduzieren die Plasma Clearance von Treprostinil um bis zu 80% verglichen mit gesunden Probanden. Deshalb sollte bei Patienten mit Leberfunktionsst\xC3\xB6rungen Remodulin nur mit Vorsicht angewendet und der Patient eng bez\xC3\xBCglich Nebenwirkungen aufgrund erh\xC3\xB6htem Remodulin \xC3\xBCberwacht werden (vgl. Pharmakokinetik)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3209 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 38
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 37
        start: 0
        values: 
        - :italic
      - *id3209
      preformatted: false
      raw_txt: 
      text: "Anwendung bei Nierenfunktionsst\xC3\xB6rungen"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3210 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3210
      preformatted: false
      raw_txt: 
      text: "Es wurden keine Studien mit Patienten mit Nierenfunktionsst\xC3\xB6rungen durchgef\xC3\xBChrt. Da Treprostinil und seine Metaboliten prim\xC3\xA4r \xC3\xBCber die Harnwege ausgeschieden werden, sollten Patienten mit Nierenfunktionsst\xC3\xB6rungen vorsichtig behandelt werden. Bei diesen Patienten sollte die Dosiserh\xC3\xB6hung noch vorsichtiger vorgenommen werden (vgl. Pharmakokinetik)."
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3211 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 25
        values: []

      formats: 
      - !ruby/object:ODDB::Text::Format 
        end: 24
        start: 0
        values: 
        - :italic
      - *id3211
      preformatted: false
      raw_txt: 
      text: "Anwendung bei \xC3\x9Cbergewicht"
    - !ruby/object:ODDB::Text::Paragraph 
      format: &id3212 !ruby/object:ODDB::Text::Format 
        end: -1
        start: 0
        values: []

      formats: 
      - *id3212
      preformatted: false
      raw_txt: 
      text: "Patienten mit \xC3\x9Cbergewicht (BMI >30 kg/m\xC2\xB2) zeigen eine geringere Clearance von Treprostinil (vgl. Pharmakokinetik)."
    subheading: ""