Last Updated June 2005
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 ProDose® AAD
nebulizer (a device that delivers medication to your lungs). AAD
stands for Adaptive Aerosol Delivery system. ProDose® senses each
patient's breathing pattern and delivers iloprost in the form
of a mist only during inhalation. It is about the size of a toaster,
weighs about 6.5 pounds and plugs into a standard electrical outlet.
No other drug should be used via ProDose®. 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 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.
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.
