ADMINISTRATION ROUTES:
Nebulised
ALTERNATIVE NAMES:
Ventavis
ICU INDICATIONS:
- Right ventricular failure with pulmonary artery hypertension after separation from cardiopulmonary bypass, and failure to improve with standard therapy.
Note: Do not administer in ICU without first discussing with the Intensive Care Specialist
PRESENTATION AND ADMINISTRATION:
Nebuliser:
20 mcg in 2 mL ampoule
Mix contents of ampoule with 3 mL 0.9% saline & administer into ventilator tubing using an Aeroneb Pro X micropump nebuliser which will deliver the dose over 30 minutes.
The nebuliser is single patient but multiple use - do not throw it away.
Do not mix with other inhaled or nebulised medications.
Information on how to set up the nebuliser is available on the ICU intranet
DOSAGE:
Nebuliser:
20 mcg nebulised given maximum 2 hourly
Maximum duration of administration is 48 hours at this frequency. If ongoing treatment required beyond this, give 20 mcg QID.
Initially reduce frequency of administration (rather than dose) to titrate to effect.
A response to iloprost is indicated by an increase in cardiac output or mixed venous oxygen saturation, often with reduction in central venous pressure. There may be minimal or no change in pulmonary artery pressure (even though pulmonary vascular resistance has fallen).
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose adjustment is not required for patients with GFR > 30 mL/min. The effect of dialysis on iloprost is unknown.
DOSAGE IN PAEDIATRICS:
Iloprost should not be administered to children or adolescents under 18 years of age.
CLINICAL PHARMACOLOGY:
Iloprost is a synthetic prostacyclin analog. After inhalation, it causes direct vasodilatation of the pulmonary arterial bed with subsequent decrease in pulmonary vascular resistance & increase in cardiac output and mixed venous oxygen saturation. Effects on systemic vascular resistance & systemic arterial pressure are minor. The risk of rebound pulmonary artery hypertension seen with inhaled nitric oxide does not appear to be present with iloprost. Similarly, it does not cause hypotension & tends to improve oxygenation.
There may be an additional benefit to using iloprost with sildenafil as they have different pathways of action.
CONTRAINDICATIONS:
- Known hypersensitivity to iloprost
- Severe hepatic impairment (see WARNINGS below)
- Severe asthma or COPD (relative contraindication - see WARNINGS below)
- Pregnancy (iloprost should only be used in pregnancy if the potential benefits to the mother justify the risk to the fetus)
WARNINGS:
Use with caution in patients with mild to moderate hepatic dysfunction. The initial dosing frequency should be decreased with intervals of 3-4 hours between nebulisers. Thereafter the dosing interval may be shortened based on individual tolerability.
Bronchospasm of varying severity may be induced by iloprost. Patients with bronchial hyperreactivity are more susceptible. Use with caution in patients with severe asthma or chronic obstructive pulmonary disease.
PRECAUTIONS:
General:
Iloprost should only be administered in the presence of a cardiac output monitor (such as a pulmonary artery catheter) so that its efficacy can be evaluated.
Laboratory Tests:
No tests are required in addition to routine ICU blood tests
Drug/Laboratory Test Interactions:
None known
Pregnancy:
Relatively contraindicated. See CONTRAINDICATIONS above.
Nursing Mothers:
Iloprost is excreted into maternal milk in animal studies. No human data is available.
Paediatric Use:
Iloprost should not be administered to children or adolescents under 18 years of age.
IMPORTANT DRUG INTERACTIONS IN ICU:
Iloprost may increase the antihypertensive effect of vasodilating and antihypertensive agents.
Iloprost inhibits platelet function so its use with anticoagulants (heparin, warfarin) or other inhibitors of platelet aggregation may increase the risk of bleeding. If bleeding occurs, iloprost administration should be stopped immediately.
ADVERSE REACTIONS:
General:
Bleeding events (epistaxis, haemoptysis, haematoma), thrombocytopaenia
Cardiovascular:
Vasodilation, hypotension, syncope
Respiratory:
Bronchospasm, chest pain, cough, dyspnoea, pharyngolaryngeal pain
Neurological:
Headache, dizziness
Gastrointestinal:
Nausea, diarrhoea, vomiting, mouth and tongue irritation. May increase liver enzymes
Skin:
Rash