iloprost


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iloprost

(eye-lo-prost) ,

Ventavis

(trade name)

Classification

Therapeutic: vasodilators
Pharmacologic: prostacyclins
Pregnancy Category: C

Indications

Pulmonary arterial hypertension (WHO Group 1).

Action

Dilates pulmonary and arterial vasculature.

Therapeutic effects

Improved exercise capacity.

Pharmacokinetics

Absorption: Unknown.
Distribution: Unknown.
Metabolism and Excretion: Any absorbed iloprost is metabolized.
Half-life: 20–30 min (plasma).

Time/action profile (improved exercise capacity)

ROUTEONSETPEAKDURATION
Inhaln unknownunknownup to 2 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Systolic BP <85 mm Hg; Lactation: Lactation.
Use Cautiously in: Concurrent use of drugs or coexisting medical conditions that may ↑ risk of syncope; COPD, asthma, or acute pulmonary infection (may ↑ risk of bronchospasm); Hepatic impairment (may need to ↑ dosing interval); Pediatric: Safety not established; Obstetric: Use only if maternal benefit outweighs fetal risk.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • fainting
  • headache
  • insomnia

Ear, Eye, Nose, Throat

  • epistaxis

Respiratory

  • cough (most frequent)
  • bronchospasm
  • dyspnea
  • hemoptysis
  • wheezing

Cardiovascular

  • HF (life-threatening)
  • vasodilation (most frequent)
  • chest pain
  • hypotension
  • peripheral edema
  • supraventricular tachycardia

Gastrointestinal

  • diarrhea
  • gingival bleeding
  • nausea
  • vomiting

Genitourinary

  • renal failure

Dermatologic

  • facial flushing

Musculoskeletal

  • back pain
  • jaw-muscle spasm
  • muscle cramps

Interactions

Drug-Drug interaction

↑ risk of hypotension with other vasodilators or diuretics.Risk of bleeding may be ↑ by anticoagulants.

Route/Dosage

Inhalation (Adults) 2.5 mcg initially, then 5 mcg/dose 6–9 times daily; not more than every 2 hr.

Hepatic Impairment

Inhalation (Adults) Child Pugh Class B or C—Consider ↑ dosing interval to every 3–4 hr.

Availability

Solution for inhalation: 10 mcg/mL ampules, 20 mcg/mL ampules

Nursing implications

Nursing assessment

  • Assess respiratory status (exercise intolerance, symptoms, deterioration) prior to and periodically during therapy.
  • Monitor vital signs prior to and throughout therapy. Do not administer if BP <85 mm Hg.
  • Assess for signs of pulmonary edema (dyspnea, jugular venous distension). If signs occur, discontinue iloprost immediately; may be a sign of pulmonary venous hypertension.

Potential Nursing Diagnoses

Activity intolerance (Indications)
Ineffective breathing pattern (Indications)

Implementation

  • Avoid iloprost contact with skin or eyes, or oral ingestion.
  • Inhalation: Prepare medication by one ampule of iloprost into Prodose ADD System or I-neb ADD system medication chamber immediately before use. Do not mix with other medications. Administer 6–9 times/day during waking hours, according to patient's needs and tolerability. Discard solution remaining in chamber after inhalation. Follow manufacturer's instructions for cleaning components after administration of each dose.

Patient/Family Teaching

  • Instruct patient in use of iloprost and Prodose ADD System or I-neb ADD system, frequency, ampule dispensing, and cleaning of equipment. See manufacturer's instructions. Advise patient that inhalation intervals should not be less than 2 hr, but acute benefits of medication may not last 2 hr.
  • May cause dizziness and fainting due to hypotension. Caution patient to change positions slowly to minimize orthostatic hypotension.

Evaluation/Desired Outcomes

  • Improved exercise tolerance, decrease in symptoms of pulmonary edema, and lack of deterioration in patients with pulmonary arterial hypertension.
References in periodicals archive ?
Epoprostenol sentetik bir prostasiklin iken treprostinil, iloprost ve beraprost prostasiklin analoglaridir (prostanoidlerdir).
TABLE 2 Medical treatment of systemic scleroderma (5-9) Organ-specific problem/symptom Treatment Raynaud's phenomenon Nifedipine, verapamil, losartan, iloprost, prazosin, bosentan * Pulmonary hypertension Bosentan, * iloprost, captopril, enalapril, sildenafil Interstitial lung disease Cyclophosphamide, prednisone Cardiomyopathy or Antiarrhythmics, diuretics, arrhythmias digoxin, pacemaker, transplant Renal failure or crisis Captopril, kidney dialysis, transplant Skin fibrosis Methotrexate, cyclosporine, D- penicillamine Arthralgias Ibuprofen, acetaminophen GERD, gastroparesis, diarrhea [H.
For patients in functional class III, five drugs are available: bosentan, sildenafil, intravenous epoprostenol, inhaled iloprost, and subcutaneous or intravenous treprostinil.
2] analog, was a product of Alexis; and iloprost (Ilomedin[R]) was from Schering.
Professor Ralph Kester had been accused of failing to complete patients' records in line with the protocol of the study into the efficacy and safety of the medicine Oral Iloprost.
Still under final investigation in Germany is the use of aerosolized prostacyclin or a stable analog iloprost (Ilomedin).
Proof of vasoreactivity with iloprost in pulmonary arterial hypertension
The treatment of digital ulcers in patients with SLE includes iloprost infusion, bosentan, and immunosuppressive therapy (cyclophosphamide and pulse methylprednisolone).
Recent attention has also been given to vasodilators, such as Iloprost, (51-53) and anticoagulants, such as Enoxaparin (54) as potential disease modifying agents in early stage, pre-collapse osteonecrosis.
epoprostenol [Flolan], treprostinil [ Remodulin] and iloprost [Ventavis]).
STEP-1 calismasinda bosentana ek olarak, inhale iloprost tedavisinin on iki haftalik izlemde inhalasyon sonrasi ADYM'de +26 m gibi sinirda bir artis sagladigi bildirilmistir (p=0.