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 dilate.

Iloprost is used in conditions such as scleroderma where there may be very poor blood flow to the fingers resulting in ulcers and sometimes gangrene of the fingers. 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

If you stop iloprost for any reason you must contact your doctor.

How will your condition be monitored?

• While having an iloprost infusion, you will be closely monitored in terms of blood pressure, heart rate and side effects such as nausea and headache.
• Your rheumatologist will then monitor your response over time and a mutual decision can be made to repeating the infusion. It may be given at the onset of winter to reduce the chance of severe circulation problems which are more common in colder weather.

How is iloprost given?

• Iloprost is given intravenously. A small needle is inserted into a vein and the medication is infused. It is given over 6 hours for 3-5 days. Some hospitals may also give this medication 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.
The recommended dosage varies between 1.5-2ng/kg/min dependent on the patient’s tolerance.

Can other medicines be taken with iloprost?

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

Iloprost may increase the blood pressure lowering effect of anti-hypertensive medications eg, calcium channel blockers and ACE inhibitors. If low blood pressure occurs this may be managed with reducing the iloprost infusion rate or temporarily with holding anti-hypertensives on the day of your infusion. It is very important to discuss this with your doctor.

Iloprost can increase the risk of bleeding by inhibiting 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?

ou 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 ceased for a period of time if required. Medications to help with common side effects such as nausea and headache can be given.

Iloprost side effects cease rapidly with stopping the infusion.

Common possible side effects include:

• Headache
• Nausea and vomiting
• Low blood pressure
• Flushing
• Diarrhoea
• Abdominal pain
• Chest pain
• Dizziness
• Shortness of breath
• Cough

Less common or rare possible side effects include:

• Jaw pain
• Itch
• Bleeding

What precautions are necessary?

Infections

• There is no increased risk of infection as this medication does not suppress the immune system.

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 eg from a stomach ulcer
• if there has been a recent heart attack or unstable angina
• if you have problems with your breathing such as asthma or COPD.

Use with other medicines

• Some medications as discussed above may need to be temporarily with held on the infusion days.

Vaccines

• Iloprost is not an immunosuppressive medication and does not affect the vaccination schedule.

More information is available on Vaccinations in Rhematology and COVID-19 vaccination.

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 frequently, is strongly discouraged.

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 when taking 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 taking iloprost you must see your rheumatologist regularly to ensure the treatment is working and to minimise any possible side effects.
• If you stop iloprost for any reason you must contact your doctor.
• If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
• If you are taking iloprost and plan to become pregnant you must discuss the timing with your doctor.

For more information see the Iloprost – printable information sheet.