A Guide to Iloprost Treatment

What is it?

Iloprost is a drug that comes under the prostaglandins group of treatments. It is used to treat a range of conditions, such as scleroderma, Raynaud's phenomenon, pulmonary hypertension and other diseases where blood vessels are constricted, and so blood cannot flow to the tissues in affected areas. It is important that issues like these are treated otherwise the tissues can become damaged and lead to high blood pressure. Iloprost is prescribed if a person is suffering from ulcers of the fingers, if there is gangrene, or if a person has severe Raynaud's Phenomenon, and if other drugs such as nifedipine have not been successful in relieving symptoms.

What is it used for?

How does it work? How does it help?

Iloprost is a synthetic (man-made) version of prostacyclin. This is a molecule that is produced in the body and is a natural vasodilator. This means that it relaxes the walls of blood vessels, so that it is easier for blood to flow through.

Iloprost is helpful as:

1. It widens/dilates the blood vessels, helping them to transport more blood to all areas of the body. This increases warmth in affected areas such as the hands and feet.
2. It reduces the tendency of the blood to clot.
3. It helps to prevent and repair damage to the blood vessels.

It usually starts to come into force and show benefits immediately after administration, but it can sometimes take up to 6 weeks. Cold hands and feet may warm up straight away, and ulcers may begin to improve and heal within a few days. The positive effects of iloprost may carry on for weeks and sometimes even months after treatment.

How is it administered?

Infusion

Iloprost may be given through an infusion (drip) into your arm. This is usually continuous for ~6 hours a day for 3-5 days in a row in a hospital or in a clinic. It can sometimes be given continuously over 24 hours. In some hospitals, you will stay on the ward for 3-5 days, whereas in others you will attend the day-case unit during the day, and then return home in the evenings. The frequency of iloprost infusions is normally every 6 months, but this can be adjusted depending on the person's needs.

Inhalation

Iloprost can also be administered through inhalers rather than infusion.

Initially, the process of iloprost inhalation will be started for the patient in hospital, where they will be shown how to inhale the solution, using a nebuliser. A nebuliser is a device that turns the iloprost solution into a fine mist so that it can be inhaled into the lungs. An individual may have to stay in hospital for up to 3 days to allow for training and for monitoring their response. After this, the person can return and continue taking the medicine independently.

What are the side-effects?

When receiving treatment in hospital or in a clinic, medical professionals will observe you for potential side effects and how you respond to the treatment, through monitoring of blood pressure and electrocardiograms (test done to check heart's rhythm and electrical activity). If not under observation, such as if inhaling iloprost at home, it is important for the person to be alert to any sudden side-effects. All side-effects disappear very quickly once iloprost treatment is stopped.

Common adverse reactions include facial flushing, cough and a fall in blood pressure. Others are headache, flu syndrome, nausea and insomnia. It is crucial to get emergency medical help if any signs of allergic reactions are noticed, such as hives, difficulty breathing and swelling of the face, lips, tongue or throat. Paracetamol and anti-sickness drugs can be taken if side-effects are noticed, but it is important to check with your doctor first.

If any these serious side effects are noticed, call your doctor at once:

• feeling faint;
• pounding heartbeats or fluttering in your chest;
• coughing up blood;
• unusual bleeding (nosebleeds, bleeding gums);
• fever, chills, cough with yellow or green mucus;
• chest tightness, stabbing chest pain, wheezing, feeling short of breath;
• anxiety, sweating, pale skin, severe shortness of breath, wheezing, gasping for breath, cough with foamy mucus, chest pain, fast or uneven heart rate.

Restrictions

There are some circumstances where iloprost cannot be taken. These include if you suffer from:

• unstable angina;
• a heart condition such as heart valve defects;
• any problems with liver function;
• breathing problems such as asthma or chronic obstructive pulmonary disease;
• a peptic ulcer (open sores in the lining of your stomach or the upper part of the small intestine);
• a recent stroke or heart attack;

Your doctor will be able to inform you if you are unable to have iloprost treatment and the full reasoning behind this.

Additional medications

Pending your doctor's advice, usual medications can still be taken before and after a course of iloprost treatment. Your doctor will advise the patient on whether or not they should continue taking medications during a course of treatment, as certain drugs can also act to widen blood vessels or lower blood pressure. To ensure that this is done, SRUK recommends individuals to take a list of their medications with them when going to their first day of treatment.

Iloprost should not be taken with the following medicines except upon the advice of your doctor:

• Antihypertensives (blood pressure medicine)
• Anticoagulants and antiplatelets (blood thinning medicine)
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

Iloprost does not affect vaccinations, so these can be had before and after a course of treatment. In the small chance that a vaccination is being administered during treatment, a medical professional will be able to provide guidance.

Pregnancy/breastfeeding

There have been no conclusive results on whether or not iloprost affects fertility. The guidelines currently are that iloprost should only be prescribed to a pregnant woman in extenuating circumstances where the disease is severe. If pregnant or if a person is planning on starting a family, the patient should tell their doctor prior to treatment. Likewise, there has been no research on the drug's activity and influence in breastfeeding, therefore breastfeeding is best avoided whilst taking iloprost.

CONCLUSION

If you have any questions regarding iloprost treatment or any other medications, SRUK strongly encourages you to bring these up with a medical professional. Queries can also be brought to SRUK on 020 7000 1925, or to SRUK's helpline on 0800 311 2756.

References:

1. https://www.versusarthritis.org/about-arthritis/treatments/drugs/iloprost/
2. https://bnf.nice.org.uk/drug/iloprost.html
3. https://www.gosh.nhs.uk/medical-information/medicines-information/iloprost
4. https://www.drugs.com/cdi/iloprost.html
5. https://patient.info/medicine/iloprost-for-pulmonary-arterial-hypertension-ventavis