Last Updated November 2008
What is iloprost?
Iloprost is an inhaled medication used to treat pulmonary arterial hypertension (PAH). It is a synthetic medication (not obtained from other humans or animals). It was approved by the Food and Drug Administration (FDA) in 2004 for the treatment of PAH in patients with New York Heart Association Class III or IV symptoms. Iloprost has also been given intravenously but is not FDA approved for use by this route.
How does iloprost work?
The major action of iloprost is direct vasodilatation of the pulmonary vascular bed (opening of narrowed blood vessels in the lungs). It may also inhibit platelets from clumping together (aggregating). Improvement in exercise ability and less shortness of breath has been shown in 2 short-term (3 month) studies of inhaled iloprost. There is little data about limited long-term effects of iloprost.
How is iloprost given?
The half-life of iloprost is 20 to 30 minutes and its effects generally last for about 1.5 hours. The medication is inhaled through the mouth by a special device called the I-neb ® AAD nebulizer (a device that delivers medication to your lungs. I-neb® senses each patient's breathing pattern and delivers iloprost in the form of a mist only during inhalation. It is portable, battery-powered drug-delivery system, designed and approved for use with Ventavis® (iloprost) Inhalation Solution. AAD stands for Adaptive Aerosol Delivery, the innovative technology used by the I-neb AAD System. The I-neb AAD System turns Ventavis into an aerosol (mist) that you inhale into your lungs. The I-neb AAD System monitors your breathing to ensure that the I-neb AAD System delivers the correct amount of medicine to your lungs.. Because iloprost is an inhaled medication, patients should be careful not to expose others while taking a treatment.
Dosing of iloprost
Iloprost is initiated at a dose of 2.5 micrograms and increased to 5 micrograms (the usual dose) if the patient tolerates the lower dose. Iloprost is given 6 to 9 times per day depending upon the response and activity level of each patient. Each inhalation takes approximately 6-10 minutes depending on the breathing pattern of each patient.
What are the frequent side effects of iloprost?
The most common side effects include flushing, increased cough, low blood pressure, headache, nausea, and jaw discomfort. Dizziness, lightheadedness or fainting can occur if the blood pressure drops too low. Iloprost solution can irritate the eyes and skin.
How is iloprost supplied?
Iloprost comes in glass vials (ampules) that can be stored at room temperature. Each ampule contains 2 ml of drug (20 micrograms of iloprost). One entire ampule is used for each treatment.
How do patients obtain iloprost?
Iloprost must be prescribed by a physician and insurance approval must be obtained prior to starting therapy. Once approved by insurance, iloprost is then sent directly to patients by either of two specialty pharmacies: Accredo Health Inc. or Priority Healthcare Corporation.
Will insurance pay for iloprost?
The cost of iloprost is about $60,000-70,000 per year. Most insurance companies, as well as Medicare and Medicaid, will pay for iloprost. Often is it included under the durable goods and not routine "drugs".
Can Iloprost be taken with other medications?
Iloprost is safe to take with most medications but can cause side effects that interfere with or require changes in other medications. Check all medications with your doctor.
Could a patient be allergic to Iloprost?
This is unlikely. An ampule of iloprost does not contain preservatives or sulfites. However, any medication can cause side effects or sensitivities and patients should check with their doctor if they experience a problem.
Pregnant and nursing women
Iloprost has not been evaluated in pregnant women or women who are breastfeeding. Iloprost should be used in pregnant or nursing mothers only if the potential benefit justifies the risk to the fetus or infant.
Use in children
Iloprost has been used in children with PAH, although long-term safety and efficacy in pediatric patients has not been established.
