Iloprost Zentiva (Iloprost)

Iloprost acts on the prostacyclin pathway to provide vasodilation in pulmonary vascular disease.

• Pulmonary arterial hypertension: reduces pulmonary vascular resistance and improves exercise capacity.
• Digital ulcers associated with systemic sclerosis: promotes ulcer healing and reduces pain.
• Pulmonary hypertension (any etiology): provides vasodilatory support to lower pulmonary artery pressure.

• Iloprost is a synthetic analogue of prostacyclin (PGI2) that binds to the IP prostacyclin receptor on vascular smooth‑muscle cells. Activation of this G‑protein‑coupled receptor stimulates adenylate cyclase, increasing intracellular cyclic AMP, which leads to relaxation of pulmonary arterial smooth muscle and inhibition of platelet aggregation. The rise in cAMP also modulates endothelial function and reduces inflammatory mediator release, contributing to its therapeutic effect in the pulmonary circulation.

Iloprost may be associated with a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Headache: mild to moderate intensity, often transient, may respond to analgesics.
• Flushing: warmth and redness of the skin, typically short‑lived.
• Nausea: occasional gastrointestinal upset, may be accompanied by vomiting.
• Hypotension: drop in blood pressure during infusion, monitor vitals regularly.

Serious or Rare Side Effects

• Bleeding: increased risk of hemorrhage due to platelet inhibition, monitor for signs of bruising or hematuria.
• Severe hypotension leading to syncope: marked blood pressure fall causing fainting, requires immediate intervention.
• Pulmonary edema: fluid accumulation in the lungs, presents with dyspnea and crackles, may need hospitalization.

Prior to initiating Iloprost therapy, clinicians should evaluate patient-specific factors and monitor for potential complications.

• Renal impairment: monitor fluid balance and consider dose adjustment.
• Hepatic impairment: use with caution and assess liver function tests regularly.
• Bleeding risk: avoid in patients with active hemorrhage or uncontrolled anticoagulation.
• Pregnancy: safety not established; weigh potential benefits against risks.
• Concomitant vasodilators: monitor blood pressure closely for additive hypotensive effects.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

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

Major Interactions (Avoid)

• Concomitant anticoagulants: additive effect on bleeding risk.
• Epoprostenol: combined vasodilatory action may cause severe hypotension.

Moderate Interactions (Monitor Closely)

• Calcium channel blockers: may enhance hypotensive response.
• Beta‑blockers: can mask tachycardia associated with hypotension.
• Nitrates: additive blood pressure lowering effect.