Pronunciation: (EYE-low-prost)Class: Prostacyclin analog
Trade Names:Ventavis- Inhalation solution 20 mcg
Dilates systemic and pulmonary arterial vascular beds.
Absolute bioavailability of inhaled iloprost has not been determined. Following a 5 mcg inhalation, the C max is approximately 150 pg/mL in patients with pulmonary hypertension.
Vd after IV infusion is 0.7 to 0.8 L/kg. Protein binding is approximately 60%, primarily to albumin.
Metabolized primarily by beta-oxidation of the carboxyl side chain to tetranoriloprost. The CYP-450 plays a minor role in iloprost metabolism.
The t ½ is 20 to 30 min. Elimination is 68% in urine and 12% in feces.
Indications and Usage
Treatment of pulmonary arterial hypertension.
IV administration for treatment of severe Raynaud phenomenon associated with systemic sclerosis.
Dosage and AdministrationAdults
Inhalation Start with 2.5 mcg (as delivered to the mouthpiece). If this dose is tolerated, increase dosing to 5 mcg and maintain that dose. Take 6 to 9 times/day but not more often than every 2 h (max, 45 mcg/day).
- For aerosol administration only. Not for parenteral or oral administration.
- Do not administer iloprost inhalation solution with any aerosol-generating device other than the I-neb Adaptive Aerosol Delivery (AAD) or Prodose AAD system, or together with other aerosolized medications.
- Do not allow iloprost solution to come into contact with the skin or eyes. If accidental skin or eye contact occurs, flush exposed areas with water.
- Two ampule configurations, a 2 mL and 1 mL single-use glass ampule each containing 10 mcg per 1 mL, are available.
- The 1 mL single-use ampule delivers 10 mcg to the medication chamber and must only be used with the I-neb AAD system.
- The 2 mL single-use ampule delivers 20 mcg to the medication chamber of either of the AAD delivery systems. The 2 mL must be used with the Prodose AAD system and may be used with the I-neb AAD system.
- The 2 mL and 1 mL ampules deliver a nominal dose of either 2.5 mcg or 5 mcg at the mouthpiece of the AAD delivery system for which they are labeled for use.
- Each inhalation treatment requires 1 single-use ampule.
- For each inhalation session, transfer the entire contents of 1 opened ampule into either the I-neb AAD system or the Prodose AAD system medication chamber (2 mL ampule only) immediately before use.
- Open ampule by holding bottom of ampule with blue dot facing away from body, wrapping the included rubber pad around the entire ampule using other hand; then, using thumbs, break open the neck of the ampule by snapping the top of the ampule toward the body.
- Administer iloprost according to instructions provided by the manufacturer for use with the I-neb AAD or Prodose AAD system.
- Discard any remaining solution in the medication chamber following each inhalational session. Use of remaining solution for next inhalational session will result in unpredictable dosing.
- Follow manufacturer instructions for cleaning the I-neb AAD or Prodose AAD system components after each inhalational session.
Store unopened ampules at controlled room temperature (59° to 86°F).
Because iloprost inhibits platelet function, the risk of bleeding may be increased.Antihypertensive agents, vasodilators
The hypotensive effects of these agents may be increased by iloprost.
Laboratory Test Interactions
None well documented.
Vasodilation/flushing (27%); hypotension (11%); syncope (8%); palpitations (7%); chest pain, CHF, supraventricular tachycardia.
Headache (30%); insomnia (8%).
Nausea (13%); vomiting (7%).
Increased alkaline phosphatase, increased gamma-glutamyltransferase (6%).
Trismus (12%); back pain (7%); muscle cramps (6%).
Increased cough (39%); hemoptysis (5%); pneumonia (4%); dyspnea.
Flu syndrome (14%); tongue pain (4%); peripheral edema.
Category C .
Safety and efficacy not established.
Use with caution, usually starting at the low end of the dosage range because of the greater frequency of decreased cardiac, hepatic, or renal function, and of concomitant diseases or other drug therapy.
Use with caution in patients on dialysis.
Use with caution.
Special Risk Patients
Use has not been evaluated in patients with pulmonary hypertension, COPD, severe asthma, or acute pulmonary infections.
Stop treatment immediately if pulmonary edema occurs when administered to patients with pulmonary hypertension; this may be a sign of pulmonary venous hypotension.
Syncope may occur. Use with caution in patients with low systemic BP to avoid further hypotension; do not use in patients with systolic BP less than 85 mm Hg.
Extension of the pharmacologic effects, including diarrhea, flushing, headache, hypotension, nausea, and vomiting.
- Advise patient or caregiver to use iloprost only as prescribed with the I-neb AAD or Prodose AAD system, pulmonary drug delivery devices, following the manufacturer instructions.
- Ensure patient or caregiver has been trained in proper administration techniques, including dosing frequency, opening ampules, transferring solution, disposal of empty ampule, I-neb AAD or Prodose AAD system operation, and equipment cleaning and maintenance.
- To avoid interruptions in therapy caused by equipment malfunction, ensure patient or caregiver has easy access to a backup I-neb AAD or Prodose AAD system.
- Caution patient or caregiver to avoid oral ingestion or skin or eye contact with iloprost. Advise patient if accidental skin or eye contact occurs to flush the exposed area with water.
- Caution patient or caregiver not to put any other medications in the I-neb AAD or Prodose AAD system while using iloprost.
- Advise patient or caregiver that iloprost should be inhaled at intervals of no less than 2 h and that the beneficial effects of iloprost may not last 2 h. Caution patient or caregiver against increasing the frequency of administration if beneficial effects do not last the entire time between treatments.
- Caution patient not to change the dose or stop taking unless advised by health care provider.
- Caution patient or caregiver that BP may fall during or shortly after iloprost administration and that dizziness or fainting can occur. Advise patient to stand up slowly when getting out of a chair or bed. Advise patient or caregiver to notify health care provider if dizziness gets worse or if fainting occurs.
- Advise patient or caregiver that the most common side effects of iloprost therapy (aside from low BP and fainting) include reddening of the face caused by widening of blood vessels (flushing), increased cough, headache, nausea, and spasms of the jaw muscles that cause trouble opening the mouth. Advise patient or caregiver to notify health care provider if any of these develop and are intolerable.
Copyright © 2009 Wolters Kluwer Health.
- Iloprost MedFacts Consumer Leaflet (Wolters Kluwer)
- iloprost Inhalation, oral/nebulization Advanced Consumer (Micromedex) - Includes Dosage Information
- Ventavis Prescribing Information (FDA)
- Ventavis Consumer Overview