Treatment of pulmonary hypertension (prostacyclin
analogue).
A synthetic analogue of Prostacyclin (PGI2) used to treat pulmonary arterial hypertension (PAH), scleroderma, Raynaud''s phenomenon and ischemia. It acts through elevation of cAMP by binding to the prostacyclin receptor (IP receptor). Iloprost inhibits the ADP, thrombin, and collagen-induced aggregation of human platelets with an ED50 of about 13 nM. In whole animals, iloprost acts as a vasodilator, hypotensive, antidiuretic, and prolongs bleeding time.
ChEBI: Iloprost is a carbobicyclic compound that is prostaglandin I2 in which the endocyclic oxygen is replaced by a methylene group and in which the (1E,3S)-3-hydroxyoct-1-en-1-yl side chain is replaced by a (3R)-3-hydroxy-4-methyloct-1-en-6-yn-1-yl group. A synthetic analogue of prostacyclin, it is used as the trometamol salt (generally by intravenous infusion) for the treatment of peripheral vascular disease and pulmonary hypertension. It has a role as a platelet aggregation inhibitor and a vasodilator agent. It is a monocarboxylic acid, a secondary alcohol and a carbobicyclic compound.
This more chemically and biologically stable derivativeof prostacyclin is available as a solution (10 μg/mL)for nasal inhalation (Ventavis by Actelion) via a preciselycalibrated inhalation device for the treatment of pulmonaryarterial hypertension (PAH). Patients inhale 6 to 8 puffs ofaerosolized iloprost every 2 to 3 hours to produce a directvasodilatory effect on pulmonary blood vessels, therebydecreasing vascular resistance. Side effects of coughing,flushing, headaches, and jaw pain have been most commonlyreported.
Iloprost is administered as an inhalation solution of a prostacyclin analog for the treatment of NYHA class III and class
IV PAH. The drug also can be administered as an IV infusion. It is stable at room temperature and to light, with a body
half-life of 30 minutes. Iloprost has approximately 10 times greater potency than prostacyclin as a vasodilator of the
pulmonary blood vessels; this greater potency of inhaled iloprost results from coating of the drug on the alveoli of the
lungs.
Studies have
reported minor side effects, such as coughing, headaches, and jaw pain.
Potentially hazardous interactions with other drugs
Anticoagulants: enhanced anticoagulant effect and
increased risk of bleeding with heparin, coumarins
and phenindione, as iloprost inhibits platelet
aggregation.
Increased risk of bleeding with NSAIDs, aspirin,
clopidogrel, eptifibatide and tirofiban.
On intravenous infusion iloprost is rapidly cleared from
the plasma by oxidation. About 80% of the metabolites
are excreted in urine and 20% in the bile.
