Treatment of pulmonary hypertension with the continuous infusion of a prostacyclin analogue, iloprost

Abstract

Objective-To compare prostacyclin with an analogue, iloprost, in treatment of severe pulmonary hypertension. Patients-Eight patients with severe pulmonary hypertension: primary in five, thromboembolic pulmonary hypertension in three. Methods-All patients underwent right heart catheterisation. Mean (SEM) right atrial pressure was 9.9 (2.2) mm Hg, mean pulmonary artery pressure 67.4 (3.0) mm Hg, cardiac index 1.75 (0.13) l/min/m 2 and mixed venous oxygen saturation 59.1(3.1)%. Continuous intravenous epoprostenol (prostacyclin, PGI 2 ) or iloprost was given for phase I (three to six weeks); the patients were then crossed over to receive the alternate drug in an equivalent phase II.

Intravenousiloprost bridging to orthotopic liver transplantation in portopulmonary hypertension

“…Moreover, iloprost has a biphasic disposition, with longer half-lives of 3-4 and 30 min, in contrast to the half-life ofv5 min of epoprostenol [19]. In addition, much lower doses of iloprost are needed for a comparable haemodynamic effect [20].…”

Pulmonary arterial hypertension in children

“…It has a similar molecular structure to prostacyclin and works though prostacyclin receptors present on vascular endothelial cells. Iloprost is more stable than epoprostenol and can be stored at room temperature without needing protection from light [74]. It has a biological half-life of 20-30 min [77].…”

“…Although inhaled iloprost, a stable synthetic analogue of prostacyclin, has been shown to be efficacious in improving haemodynamics and exercise capacity in pulmonary arterial hypertension patients [72][73][74][75][76], the clinical experience with children is extremely limited. It has a similar molecular structure to prostacyclin and works though prostacyclin receptors present on vascular endothelial cells.…”

Intravenous iloprost for pulmonary arterial hypertension: still waiting for evidence

“…iloprost was effective in improving exercise capacity and pulmonary haemodynamics in PAH. However, these studies were limited in size (eight and 13 patients treated with iloprost [12,13], respectively) and included heterogeneous forms of pulmonary hypertension. Intravenous iloprost was never evaluated in a formal randomised placebocontrolled trial.…”

“…Short-term open-label [12] and observational [13] studies suggested i.v. iloprost was effective in improving exercise capacity and pulmonary haemodynamics in PAH.…”