Iloprost Rafarm (Iloprost)

Iloprost Rafarm is a prostacyclin analogue used in the management of vascular disorders affecting the pulmonary circulation and skin.

• Pulmonary arterial hypertension: improves exercise capacity, delays disease progression, and reduces pulmonary vascular resistance.
• Digital ulcers associated with systemic sclerosis: promotes ulcer healing and reduces the formation of new ulcers.
• Adjunct therapy in PAH: provides inhaled vasodilation for patients unsuitable for oral or intravenous prostacyclin therapy.

• Iloprost is a synthetic prostacyclin analogue that selectively activates the IP (prostacyclin) receptor on vascular smooth‑muscle cells. Receptor activation increases cyclic AMP levels, leading to potent vasodilation of pulmonary arteries and inhibition of platelet aggregation, thereby improving pulmonary hemodynamics and tissue perfusion.

Iloprost may cause a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Cough: irritation of the airway during inhalation.
• Throat irritation: discomfort or soreness in the throat.
• Headache: mild to moderate intensity.
• Nausea: occasional feeling of queasiness.
• Flushing: transient warmth and redness of the skin.
• Dizziness: light‑headed sensation, especially on standing.

Serious or Rare Side Effects

• Hypotension: significant drop in blood pressure requiring medical attention.
• Pulmonary edema: fluid accumulation in the lungs.
• Severe bronchospasm: acute narrowing of the airways.
• Bleeding events: increased risk of hemorrhage.
• Chest pain: angina‑like discomfort.
• Cardiac arrhythmia: irregular heart rhythm.

Before initiating Iloprost therapy, clinicians should consider several safety measures.

• Blood pressure monitoring: check for hypotension before and during treatment.
• Bleeding risk assessment: evaluate concurrent anticoagulant use.
• Respiratory status: avoid in patients with active severe asthma or COPD exacerbations.
• Recent hemoptysis: contraindicated in patients with recent coughing up of blood.
• Pregnancy and lactation: use only if potential benefit justifies potential risk.
• Store at room temperature: keep in original container, protect from moisture and light.

Iloprost can interact with other medications that affect vascular tone or coagulation.

Major Interactions (Avoid)

• Anticoagulants (e.g., warfarin): may increase bleeding risk.
• Endothelin receptor antagonists: additive hypotensive effect.
• Phosphodiesterase‑5 inhibitors: excessive vasodilation and hypotension.

Moderate Interactions (Monitor Closely)

• Aspirin and other NSAIDs: may enhance bleeding tendency.
• Beta‑blockers: may blunt the desired vasodilatory response.
• Calcium channel blockers: potential additive blood pressure lowering effect.