Inhaled iloprost for the control of pulmonary hypertension

Abstract

Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by an elevated pulmonary arterial pressure and vascular resistance with a poor prognosis. Various pulmonary and extrapulmonary causes are now recognized to exist separately from the idiopathic form of pulmonary hypertension. An imbalance in the presence of vasoconstrictors and vasodilators plays an important role in the pathophysiology of the disease, one example being the lack of prostacyclin. Prostacyclin and its analogues are potent vasodilators with antithrombotic, antiproliferative and anti-inflammatory qualities, all of which are important factors in the pathogenesis of precapillary pulmonary hypertension. Iloprost is a stable prostacyclin analogue available for intravenous and aerosolized application. Due to the severe side effects of intravenous administration, the use of inhaled iloprost has become a mainstay in PAH therapy. However, owing to the necessity for 6 to 9 inhalations a day, oral treatment is often preferred as a first-line therapy. Numerous studies proving the efficacy and safety of inhaled iloprost have been performed. It is therefore available for a first-line therapy for PAH. The combination with endothelin-receptor antagonists or sildenafil has shown encouraging effects. Further studies with larger patient populations will have to demonstrate the use of combination therapy for long-term treatment of pulmonary hypertension.

Meta-Analysis of Randomized Controlled Trials on Treatment of Pulmonary Arterial Hypertension

“…2 Iloprost is an inhaled prostacyclin drug that can act on the pulmonary blood vessels selectively and improve the hemodynamics of patients with PAH effectively; in addition, compared with traditional prostacyclin drugs, it has a longer halflife and can be administered by aerosol inhalation, avoiding the occurrence of infections, deep venous thrombosis, catheter displacement or pneumothorax resulting from previous iv medication. 3 These drugs can alleviate the symptoms in patients with PAH, and improve exercise capacity, hemodynamics and outcome. The clinical relevance of these effects, however, has been recently challenged, 4-6 mainly because of the limited amelioration of exercise capacity by medication, short duration and the small size of the individual studies, which have precluded any insight into the prognostic relevance of the treatments.…”

Long-term results of surgical repair of congenital heart defects in children with severe pulmonary arterial hypertension treated with perioperative inhaled iloprost

“…On the other hand, common adverse effects of inhaled iloprost include cough, headache, flushing, and jaw pain. In their study, Krug et al [16] showed serious side effects such as syncope, tachycardia, pneumonia, and dyspnea in 2 to 5% of the patients. In our study, no acute toxicities related to the inhalation of aerosolized iloprost and no systemic side effects were observed.…”

Pulmonary Arterial Hypertension is Normalized Following Six Years of Inhaled Iloprost Treatment in a Patient with Systemic Sclerosis

“…However, the effect of inhaled iloprost terminates between 6.4 to 9.5 minutes after inhalation, and it is necessary to use inhaled iloprost 6 to 12 times a day. The usual dosage is 2.5 μg per inhalation although it can be increased to 5 μg per inhalation [11]. PAH is characterized by the elevation of PAP as well as by early mortality.…”