Iloprost Zentiva (Iloprost)

Iloprost is a prostacyclin analogue indicated for several vascular conditions that benefit from vasodilation and antiplatelet effects.

• Pulmonary arterial hypertension: improves exercise capacity and hemodynamic parameters in patients with PAH.
• Digital ulcers associated with systemic sclerosis: promotes healing of ischemic skin lesions and reduces ulcer recurrence.

• Iloprost is a synthetic analogue of prostacyclin (PGI2) that binds to and activates the prostacyclin (IP) receptor on vascular smooth‑muscle cells and platelets. Receptor activation stimulates adenylate cyclase, raising intracellular cyclic AMP, which leads to relaxation of pulmonary arterial smooth muscle and inhibition of platelet aggregation, thereby lowering pulmonary vascular resistance.

Iloprost may cause a range of adverse reactions, most of which are related to its vasodilatory properties and local inhalation effects.

Common Side Effects

• Cough: irritation of the airways during inhalation.
• Throat irritation or soreness.
• Headache: mild to moderate intensity.
• Flushing: warmth and redness of the skin.
• Nausea or dyspepsia.
• Jaw pain or muscle ache.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure.
• Pulmonary edema: fluid accumulation in the lungs.
• Significant bleeding: due to platelet inhibition.
• Bronchospasm: acute narrowing of the airways.
• Chest pain or myocardial ischemia.

When using Iloprost, clinicians should observe several safety measures to minimise risks and optimise therapeutic benefit.

• Blood pressure monitoring: check for hypotension before and during therapy.
• Bleeding risk assessment: evaluate patients on anticoagulants or with bleeding disorders.
• Pulmonary function evaluation: ensure adequate lung capacity for inhalation.
• Recent myocardial infarction: use with caution in patients with recent cardiac events.
• Severe hypotension: contraindicated in patients with markedly low blood pressure.
• Hypersensitivity: discontinue if signs of allergic reaction occur.
• Store at room temperature: keep in original container, protect from moisture and light.

Iloprost can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Concomitant use with other prostacyclin analogues: additive vasodilation may cause severe hypotension.
• Potent vasodilators (e.g., nitroglycerin): risk of profound blood pressure fall.
• High‑dose anticoagulants (e.g., warfarin): increased bleeding tendency.

Moderate Interactions (Monitor Closely)

• Antiplatelet agents (e.g., aspirin, clopidogrel): monitor for signs of bleeding.
• Endothelin receptor antagonists (e.g., bosentan): may enhance pulmonary vasodilatory effect.
• CYP450 inhibitors (e.g., ketoconazole): possible increase in iloprost exposure.