iloprost


Also found in: Wikipedia.

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 ?
Vasoreactivity testing was performed with inhaler iloprost which showed that patient had negative vasodilator response.
(76-78) In a double blind, randomized controlled study of 41 patients with only a 3-month follow-up, Mayerhoefer and colleagues (76) showed a significant improvement in functional knee scores and a 58% regression of lesion size when using oral iloprost. The control cohort treated with tramadol also showed a significant improvement in functional knee scores from baseline similar to that of iloprost.
Management of intra-arterial injection injury with iloprost. Lancet 1994; 343: 419 (Letter).
Scholz, "Inhibition of tumour necrosis factor production in endotoxin-stimulated human mononuclear leukocytes by the prostacyclin analogue iloprost: cellular mechanisms," Cytokine, vol.
Of note, these results did not depend upon therapeutic intervention since all the patients examined in this study underwent the same therapeutic protocol (iloprost 0,5-2,0 ng/kg/min).
(5) The prostacyclin analog iloprost reduced lung cancer development in mice and was evaluated in a randomized phase II trial in high-risk patients defined by a greater than 30-pack-year smoking history and by having atypical cells in their sputum.
Several classes of medication are used to treat PAH, including prostanoids such as iloprost, endothelin receptor antagonists like bosentan, and phosphodiesterase type 5 (PDE5) inhibitors.
We treated 2 very low birth weight (VLBW) infants with respiratory distress syndrome suffering from refractory hypoxic respiratory failure complicated with severe pulmonary hypertension with inhaled iloprost. The first infant was an 800 gram male and the second case was a 920 gram female.
At present, in addition to calcium channel blocker; there are several modalities of therapy available and include: oral therapies like phosphodiesterase type (5) inhibitors (Sildenafil and Tadalafil) and endothelin-receptor antagonists (Bosentan and Ambrisentan), inhalational therapy (Iloprost and Treprostinil), Infusion therapy (Epoprostenol and Treprostinil) and subcutaneous therapy (Treprostinil).
For example, prednisolone and hydrocortisone are included, but not dexamethasone, and epoprostonol is included, but not iloprost. Other omissions relevant to intensive care and cardiac anaesthetic practice include vasopressin, terlipressin, sildenafil and bosentan.