iloprost
CLINICAL USE
Prostacyclin analogue:Treatment of pulmonary hypertension Relief of pain, promotion of ulcer-healing and limb salvage in patients with severe peripheral arterial ischaemia (unlicensed product)
DOSE IN NORMAL RENAL FUNCTION
Pulmonary hypertension: Nebulised: 2.5–5 mcg per inhalation —session 6 to 9 times per dayIV: Usually 1–8 ng/kg/min, but can —use higher doses (up to 25 ng/kg/min) according to responseSevere peripheral arterial ischaemia: Dose is adjusted according to —individual tolerability within the range of 0.5–2 ng/kg/min over 6 hours daily
PHARMACOKINETICS
DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
ADMINISTRATION
Reconstition
Dilute 0.1 mg with 500 mL sodium chloride 0.9% or glucose 5%. Final concentration = 0.2 micrograms iloprost/mL
Route
Nebulised,
IV infusion
via peripheral vein or central venous catheter
Rate of Administration
Infuse 0.1 mg over 6 hours daily (see below)
Comments
Treatment should be started at an infusion rate of 10 mL/hour for 30 minutes, which corresponds to a dose of 0.5 nanograms/kg/minute for a patient of 65 kgThen increase dose in steps of 10 mL/hour every 30 minutes up to a rate of 40 mL/hour (50 mL/hour if patient’s body weight is more than 75 kg)If side effects occur (e.g. headache, nausea, or an undesired drop in BP), infusion rate should be reduced until the tolerable dose is found; if side effects are severe, infusion should be interruptedFor rest of the treatment period, continue with dose found to be tolerated in the first 2–3 days
OTHER INFORMATION
BP and heart rate must be measured at the start of the infusion and after every increase in doseDuration of treatment is up to 4 weeks. Shorter treatment periods (3–5 days) are often sufficient in Raynaud’s phenomenonIloprost infusions can also be used to control blood pressure during a scleroderma hypertensive crisisFor fluid-restricted patients, dilute 0.1 mg iloprost with 50 mL sodium chloride 0.9%, and run at a rate of 1–4 mL/hourToxic by inhalation, contact with skin, and if swallowed.