Drug Interaction:
Drug interactions -summary-
Vasodilators / antihypertensives agents -
iloprost has the potential to increase the
hypotensive effects of vasodilators and antihypertensive agents
Indication:
Primary pulmonary hypertension
Adverse Reaction:
Adverse reactions-
Cardiovascular - hypotension 11% paplitations 6% syncope 7%
vasodilation( flushing ) 26%
CNS- headache 30% insomnia 7%
GI - nausea 13% vomiting 7%
Lab test abnormalities - abnormal lab test 6% increased alkaline phosphate 6%
increased gamma glutamyltransferase 6%
Respiratory - hemoptysis 5% increased cough 39% pneumonia 4%
Miscellaneous - back pain 6% flu syndrome 14% muscle cramps %
tongue pain 4% trismus 12%
Contra-Indications:
Special Precautions-
Syncope - because of risk of syncope monitor vital signs while initiating iloprost
The occurance of therapeutic syncope may refelect a therapeutic gap or insufficient
efficacy , consider the need to adjust the dose or change therapy
Pulmonary edema- if signs of pulmonary edema occurs when inhaled iloprost is administered
in patients with pulmonary hypertension , stop the treatment immediately . This may be a sign of
pulmonary venous hypotension
Contact with iloprost solution - do not allow iloprost to come into contact with skin or eyes
avoid oral ingestion of iloprost solution
Renal function impairment- dose adjustment is not required in patients on dialysis.
Use caution in treating patients on dialysis.
Hepatic function impairment- because iloprost elimination is reduced in patients with impaired
liver function, excercise caution during iloprost therapy in patients with child -Pugh class B hepatitic
impairment
Pregnancy- use during pregnancy only if the patients benefit justifies the potential risk to
the fetus.
Lactation- decide whether to discontinue breast feeding or the drug taking into account the
importance of the drug to the mother.
Children- safety and efficacy in children have not been established
Monitoring- because of the risk of syncope, monitor vital signs while intiating iloprost.
Do not initiate iloprost in patients with systolic blood pressure less than 85mm Hg
Dosages/ Overdosage Etc:
Indication-
Primary pulmonary hypertension
Dosage-
Iloprost is intended to be inhaled using either 2 pulmonary drug delivery devices.
The first inhaled dose should be 2.5mcg (as delivered at the mouth piece)
If the first dose is well tolerated , increase dosing to 5mcg and maintain that dose,
otherwise maintain the dose of 2.5mcg
Take iloprost 6 to9 times a day ( no more than every two hours) during waking hours
according to individual need and tolerability
Maximum daily dose evaluated in clinical studies was 45mcg ( 5mcg 9 times/day)
Patient Information:
1. Advice patients receiving iloprost to use the drug only as prescribed with either of
2 pulmonary drug delivery devices. train patients in proper use of system following the
manufacturers instructions
2. Advice patients that may have a fall in blood pressure with iloprost, so may become
dizzy or even faint. Insruct patients to stand up slowly when they get up from a chair
or bed. If fainting gets worse, advice patients to consult their doctor, about dose adjustment
3. Advice patients to inhale iloprost at intervals of not less than 2 hours and that acute
benefits of iloprost may not last 2 houts.
4.Advice patients to avoid oral ingestion or skin contact of iloprost solution
5. Advice patients that the most common adverse reactions with iloprost include
flushing, increased cough, hypotension, headache, nausea, spasms of jaw muscles
that cause trouble opening the mouth and syncope.
6. Advice patients not to put any other medicines in the inhaltion drug delivery device
while using iloprost
Pregnancy and lactation:
Pregnancy-
Use during pregnancy only if the patients benefit justifies the potential risk to
the fetus.
Lactation- Decide whether to discontinue breast feeding or the drug taking into account the
importance of the drug to the mother.
Children-
Safety and efficacy in children have not been established
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