Iloprost

What is Iloprost?

Iloprost is a prostaglandin analogue or synthetic prostaglandin. Prostaglandins are hormone-like substances found within the body and have many functions. One of the functions is to allow blood vessels to widen.

Iloprost is used to treat conditions like scleroderma and Raynaud’s phenomenon, where blood flow to the fingers is very poor. This can lead to ulcers and, in some cases, gangrene. Iloprost enables the small vessels to widen and allow increased blood flow.

What benefit can you expect from your treatment?

Iloprost works quickly to improve circulation but can take up to 6 weeks to see the full effect.

Stopping iloprost

Your rheumatologist or treating doctor may choose to stop the iloprost infusion before it’s completed. Speak to your rheumatologist if you have any questions about stopping iloprost.

How will your condition be monitored?

During an iloprost infusion, your blood pressure, heart rate, and any side effects like nausea or headaches will be closely monitored.
Your rheumatologist will check how you respond over time and together you can decide whether to repeat the infusion. It may be given at the start of winter to reduce the chance of severe circulation problems which are more common with colder weather.

How is iloprost given?

Iloprost is given intravenously. A small needle is inserted into a vein and the medicine is infused. It is given over 6 hours each day for 3-5 days. Some hospitals may also give this medicine over a 24-hour period as an inpatient.
Iloprost is usually given gradually, and the rate of infusion can be changed if side effects occur.

What is the dosage?

For infusions, the dose is based on the person’s weight, so each person’s dose may be different.

Can other medicines be taken with iloprost?

Always discuss what medicines you are taking, including any over-the-counter medicines with your doctor.

Iloprost can decrease your blood pressure even more if you are taking blood pressure medicines. If this occurs, it can be managed by slowing down the iloprost infusion or temporarily stopping your blood pressure medicines on the day of your infusion. It is important to talk to your doctor about this.

Iloprost can increase the risk of bleeding by reducing the function of platelets. Patients taking blood thinning agents such as warfarin or other inhibitors of platelet function will need to discuss their use prior to infusion.

Are there any side effects?

You might experience side effects with your treatment. Contact your doctor if you have any concerns about possible side effects.

You will be closely monitored during the infusion for side effects. The iloprost infusion can be slowed or stopped for a period of time if required. Medicines to help with common side effects such as nausea and headache can be given.

Iloprost side effects usually stop quickly once the infusion is stopped.

Most common possible side effects

Common possible side effects include:

• Headache
• Nausea and vomiting
• Low blood pressure
• Facial flushing
• Diarrhoea
• Abdominal pain
• Chest pain
• Dizziness
• Shortness of breath
• Cough or wheeze
• Injection site reaction.

Less common or rare possible side effects

• Jaw pain
• Muscle aches
• Skin rash/itch
• Abnormal liver tests
• Bleeding

What precautions are necessary?

Precautions with other diseases

Iloprost infusions may need to be delayed in the following circumstances, but it is best to be discussed between the treating rheumatologist and the patient.

• If there has been a recent bleeding episode, e.g. from a stomach ulcer.
• If there has been a recent heart attack or unstable angina.
• If there has been a recent stroke
• If you have problems with your breathing such as asthma or COPD.

Use with other medicines

• Some medicines as discussed above may need to be temporarily withheld on the infusion days. Your rheumatologist will discuss this with you.

Vaccines

• Iloprost is not an immunosuppressive medicine and does not affect the vaccination schedule.
  For more information on vaccination including the COVID-19 vaccination go to the ARA website.

Surgery

• Iloprost should not be given if surgery is occurring in the very near future due to its potential effects on bleeding.

Use with alcohol

• You may drink alcohol while taking iloprost. However, it may worsen possible side effects.
• Drinking more than 4 standard drinks on one occasion, even if infrequently, is strongly discouraged.

Cancer risk

• Iloprost is not associated with increased cancer risk.
• For general cancer prevention, stopping smoking and taking skin cancer prevention measures are recommended. It is important to use sunscreen and avoid prolonged sun exposure. A yearly skin check is recommended.
  Talk to your doctor if you have any concerns about issues relating to cancer risk.

Use in pregnancy and when breastfeeding

• Not enough is known regarding the possible side effects of iloprost. If you plan to become pregnant, it is important to discuss this with your doctor, as each case is different.
• You should not breastfeed while you are being treated with iloprost.

How to store iloprost

• Keep iloprost in a cool dry place where the temperature stays below 30°C
• Keep all medicines out of reach of children.

Important things to remember

• While receiving iloprost your rheumatologist will ensure the treatment is working and to minimise any possible side effects.
• If you are worried about any side effects, you should discuss with your rheumatologist as soon as possible.
• If you are planned to receive iloprost and plan or are pregnant you must discuss this with your rheumatologist.
  Iloprost is not listed on the Pharmaceutical Benefits Scheme (PBS), but your rheumatologist may be able to obtain approval and prescribe it through the Special Access Scheme.

For more information see the Iloprost – printable information sheet.