ILOPROST
| Iloprost (i'lo-prost) Classifications: prostaglandin; antihypertensive, pulmonary; Therapeutic:pulmonary antihypertensive Prototype: Epoprostenol Pregnancy Category: C |
Availability
2 mcg/2 mL ampule
Action
Iloprost is a synthetic analog of prostaglandin. It dilates systemic and pulmonary arterial vascular beds.
Therapeutic Effect
Dilation of the pulmonary arterial vessels reduces pulmonary hypertension.
Uses
Treatment of pulmonary arterial hypertension in patients with New York Heart Association (NYHA) class III or IV symptoms.
Unlabeled Uses
Treatment of severe Raynaud phenomenon associated with systemic sclerosis.
Contraindications
Systolic blood pressure <85 mm Hg; pregnancy (category C), lactation; children.
Cautious Use
Impaired hepatic function, elderly, renal impairment with inhaled iloprost; asthma, acute respiratory infection, COPD; elderly; dialysis, concurrent use of vasodilators and/or antihypertensive drugs.
Route & Dosage
| Pulmonary Hypertension Adult: Inhaled 2.5–5 mcg 6–9 times daily, but no more than q2h during waking hours |
Administration
Inhalation- Transfer the contents of one ampule to the drug delivery system medication chamber immediately before use. Follow instructions provided by manufacturer for the delivery system. Do not allow contact with skin or eyes.
- Do not administer if systolic BP is <85 mg Hg.
- Do not administer any sooner than 2 h after the previous dose.
- Discard any solution remaining in the medication chamber after the inhalation session.
- Store at 20°–25° C (68°–77° F).
Adverse Effects (≥1%)
CNS: Headache, insomnia. CV: Hypotension, vasodilation (flushing), palpitations, syncope, chest pain, tachycardia, congestive heart failure. GI: Nausea, vomiting. Hepatic: Increased alkaline phosphatase, increased gamma-glutamyltransferase (GGT). Musculoskeletal: Back pain, muscle cramps, trismus. Renal: Kidney failure. Respiratory: Cough, dyspnea, hemoptysis, pneumonia, peripheral edema. Body as a Whole: Flu-like syndrome, tongue pain.Interactions
Drug: Enhanced hypotension when given with other vasodilators or antihypertensive agents; increased risk of bleeding when given with other anticoagulants or antithrombotic agents.Pharmacokinetics
Distribution: 60% protein bound. Metabolism: Completely metabolized to inactive products. Elimination: Urine (major) and feces. Half-Life: 20–30 min.Nursing Implications
Assessment & Drug Effects
- Supervise ambulation, especially with concurrent use of other drugs known to cause dizziness or syncope.
- Monitor vital signs closely during initiation of drug therapy.
- Monitor for and report S&S of heart failure.
- Withhold drug and notify physician if S&S of pulmonary edema appear.
- Lab tests: Monitor blood levels of anticoagulants when used concurrently.
Patient & Family Education
- Follow directions for taking the drug (see Administration). Iloprost inhalation should be used with the Prodose AAD system. Do not use it with other types of nebulizers.
- Make position changes slowly, especially when arising from a chair or bed.
- Do not drive or engage in potentially hazardous activities until response to drug is known.
- Report any of the following to a health care provider: dizziness or fainting, especially upon exertion, or increased difficulty breathing.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug