1408 Cardiovascular 10. Pope J, et at. lloprost and cisaprost for Raynaud's phenomenon in ldraparinux Sodium (USAN, r!NN) lloprostTrometa mol (BANM, r!NNM! progressive systemic sclerosis. Available in The Cochrane Database of Systematic Reviews; Issue 2. Chichester: John Wiley; 1998 (accessed ldraparir1UX �odicp; ldr?parinu>i �pdfque; idr.lpartntjxum Ciloprosr Trornethamine; lloprost Trometamol; lloprost . 16/06/05). Natricum; Org"34006; S,l\NOHG-.3400{!; SR,34006illit:tpanap­ Tromethamine; lloprostum Trometamo!w:n; .l!lnonpocr W<YKI: Harp�R. TpoMeraMon. Pulmonary hypertension. Epoprostenol is an accepted · Met[lyf· a-,2,3,4-tri-Om-ethy!"o-0-sutfo 'a'o-glucopyr�nosyi� C12Hl,O,.CH:1N0?=481.6 part of the management of pulmonary hypertension ( l -4 i•0-2,;3-di-0-rnethyl-f!i•o-glucopyranuronosyi-(1'-,.4)-0' ATC�- 80/ACIJ, • (p. 1278.2) and the use of iloprost, a stable analogue, has -,"' been studied. Inhaled iloprost may have a role;U it was 2),6Ctr1"0-sulfo'o-D-glucopyranosyi-(l c+1)-0-2.3-di-O� ATC Vet OBd iAc:lL 1 1-4 _ found3 to improve walking-test distances, reduce severity methyl-a· L-idopyranuronosyl- )-2 ,3,6-tricO-su !fo-o-D, glucopyranoside nonasodium. of heart failure, and stabilise haemodynamic measures in Uses and Administration a 12-week study of patients with severe pulmonary hyper­ c>,H,,Na,o.,s1=1 727. 1 OS -,- 162,610- i 1--5 !idraporinux); 149920-5!?;9 (!draparinux Iloprost, a vasodilator and platelet aggregation inhibitor, is a tension, while long-term treatment of at least 1 year has stable analogue of the prostaglandin epoprostenol (prosta­ been reported to have sustained beneficial effects.4�5 It has sodium). been used for management in children. 6 Iloprost has also UNI!� H841XP2 9FN cyclin). It is given as the trometamol salt in the treatment of peripheral vascular disease and pulmonary hypertension been used successfully in a few cases to manage pulm­ but doses are described in terms of iloprost; I.3 nanograms onary hypertension in pregnant women.7 There are also Profile of iloprost trometamol is equivalent to about I nanogram of reports of effective combination therapy using inhaled ilo­ iloprost. prost with intravenous epoprostenol, 8 oral sildenafil, 9 or Idraparinux is a pentasaccharide inhibitor of factor Xa that The usual dose for peripheral vascular disease is the oral bosentan.10 Continuous intravenous infusion11 has acts in a similar manner to fondaparinux (p. 1385.3). It has a equivalent of iloprost 0.5 to 2 nanograms/kg per minute for also been tried with beneficial results over several weeks, long half-life and has been investigated in once-weekly 6 hours daily by intravenous infusion. The course of and short-term intravenous infusion for 7 days12 has been doses for the management of venous thromboembolism; treatment may be up to 4 weeks. For pulmonary successfully used for pulmonary hypertension after pulm­ however, results have been disappointing, with bleeding hypertension, the dose is I to 8 nanograms/kg per minute onary thromboendarterectomy. being a particular problem. A biotinylated version, for 6 hours daily; alternatively, iloprost may be given by 1. Baker SE, Hockman RH. Inhaled iloprost in pulmonary arterial hypertension. Ann Pharmacother 2005; 39: 1265-73. nebulised solution at a dose of 2.5 or 5 micrograms inhaled 6 idrabiotaparinux, whose action may be reversed by the 2. Krug S, et al. Inhaled iloprost for the control of pulmonary hypertension. glycoprotein avidin, is under development in an attempt to to 9 times daily, Doses should be reduced in patients with Vase Health Risk Manag 2009; 5: 465-74. improve the safety profile of the drug. hepatic or renal impairment (see below). 3. Olschewski H, et al. Inhaled iloprost for severe pulmonary hypertension. Oral iloprost is under investigation. N Eng! J Med 2002; 347: 322-9. 4. Hoeper MM, et al. Long-term treatment of primary pulmonary References. Reviews. hypertension with aerosolized iloprost, a prostacyclin analogue. N Eng! J l. Buller HR, et a!. Idraparinux versus standard therapy for venous l. Grant SM, Goa KL. Iloprost: a review of its pharmacodynamic and Med 2000; 342: 1866-70. thromboembolic disease. N Eng! J Med 2007; 357: 1094-1104. pharmacokinetic properties, and therapeutic potential in peripheral 5. Olschewski H, et al. Long-term therapy with inhaled iloprost in patients 2. Buller HR, et al. Extended prophylaxis of venous thromboembolism with vascular disease, myocardial ischaemia and extracorporeal circulation with pulmonary hypertension. Respir Med 2010; 104: 731-40. idraparinux. N Eng! J Med 2007; 357: 1105-12. procedures. Drugs 1992; 43: 889-924. 6. Tissot C, Beghetti M. Review of inhaled iloprost for the control of 3. Bousser MG, et al. Comparison of idraparinux with vitamin K pulmonary artery hypertension in children. Vase Health Risk Manag 2009; antagonists for prevention of thromboembolism in patients vvith atrial 5: 325-31. f'ibrillation: a randomised, open-label, non-inferiority trial. Lancet 2008; Administration in children. Although iloprost is unli­ 7. Elliot CA, et al. The use of iloprost in early pregnancy in patients with 371: 315-2 1. censed in the UK for use in children, the BNFC suggests pulmonary arterial hypertension. Bur Respir J 2005; 26: 168-73. that it may be given intravenously to children aged 12 8. Petkov V, et al. Aerosolised iloprost improves pubnonary haemody­ years and over in the treatment of Raynaud's namics in patients with primary pulmonary hypertension receiving continuous epoprostenol treatment. Thorax 2001; 56: 734-6. syndrome, and by nebulisation to those aged 8 years and 9. Ghofrani HA, et al. Combination therapy with oral sildenafil and inhaled over in the treatment of pulmonary hypertension, in iloprost for severe pulmonary hypertension. Ann Intern Med 2002; 136: the usual adult doses (see above), although treatment 515-22. duration should be limited to 3 to 5 days in Raynaud's 10. McLaughlin VV, et al. Randomized study of adding inhaled iloprost to existing bosentan in pubnonary arterial hypertension. Am J Respir Grit syndrome. Care Med 2006; 174: 1257-63. References. 11. Higenbottam TW, et al. Treatment of pulmonary hypertension with the continuous infusion of a prostacyclin analogue, iloprost. Heart 1998; 79: 8. Equinox Investigators. Efficacy and safety of once weekly subcutaneous l. Zulian F, et al. Safety and efficacy of Uoprost for the treatment of Rheumatology 175-9. idrabiotaparinux in the treatment of patients with symptomatic deep ischaemic digits in paediatric connective tissue diseases. (Oxford) 2004; 229-33. 12. Hsu H-H, et al. Short-term intravenous i\oprost for treatment of venous thrombosis. J Thromb Haemost 2011; 9: 92-9. 43: 2. Ivy DD, et al. Short- and long-term effects of inhaled iloprost therapy in repcrfusion lung oedema after pulmonary thromboendarterectomy. - Thorax 459-61. ----------------------------- ------ children with pulmonary arterial hypertension. JAm Coil Cardiol 2008; 2007; 62: 51: 161-9. 3. Tissot C, Beghetti M. Review of inhaled Uoprost for the control of Thrombotic microangiopathies. For reports of the use of lfenprodil Ta rtrate (r!NNM) pulmonary artery hypertension in children. Vase Health RiskManag 2009; iloprost in patients with thrombotic microangiopathies 5: 325-3 1. such as thrombotic thrombocytopenic purpura, see under ifenprodil,. Jarrratto: d'; lfenprodil, tartrato de; lfenprodili Epoprostenol, p, 1375.3. Tamas; RC-61c91; .laruato de ifenprodil; Vt<Pe�npoAJAila Administration in hepatic or renal impairment. The dose TapTpai". of intravenous iloprost should be reduced, and may need Adverse Effects and Precautions (:t)�lc(4· Benzylpiperidino)-l -(4-hydroxypher.y lipropanc) -ol. to be halved, in patients with liver cirrhosis or renal impairment requiring dialysis. In hepatic impairment, the As for Epoprostenol, p. 1375.3, Inhaled iloprost may cause initial dose of inhaled iloprost should be 2. 5 micrograms cough. given at intervals of at least 3 hours to a maximum of 6 times daily; the dose may be cautiously increased or given Effects on the cardiovascular system. Hypotension was more frequently according to patient response. seen1 in 2 of 6 patients given iloprost. Both patients recov­ ered rapidly when iloprost was stopped, although one Peripheral vascular disease. Prostaglandins, including ilo­ required intravenous atropine to correct sinus bradycardia. Pharmacopoeias. In Jp n. prost, 1"10 have been used in the treatment of peripheral Evidence of myocardial ischaemia was reported in 4 of 3 3 vascular disorders (p. 1272.3), although their role remains patients with coronary artery disease during iloprost unclear. They may be of benefit in severe Raynaud's infusion.2 The same authors3 noted a similar effect in 4 of 28 Profile syndrome (see Vasospastic Arterial Disorders, p. 1275.3), patients with stable angina in a subsequent study. According to one study,4 there might be an increased risk Ifenprodil tartrate is a vasodilator, with alpha-adrenoceptor that is complicated by ulceration. Systematic review10 sug­ of thromboembolism in some patients given iloprost, due to blocking properties, used in peripheral vascular disorders gests that intravenous iloprost produces prolonged benefit platelet activation and enhanced coagulation. (p. 1272.3). It is given in usual oral doses of 40 to 60 mg in Raynaud's phenomenon secondary to scleroderma. The benefits of oral iloprost are less clear. It is also unclear 1. Upward JW, et al. Hypotension in response to iloprost, a prostacyc\in daily, and has also been given by deep intramuscular Br J Clin Pharmacol l986; whether iloprost infusion is of benefit in occlusive periph­ analogue. 21: 241-3. injection, slow intravenous injection, or intravenous 2. Bugiardini R, et al. Myocardial ischemia induced by prostacyclin and infusion. eral arterial disease due to atherosderosis: although a iloprost. Clin Pharmacal Ther 1985; 38: 101-8. meta-analysis of (conflicting) controlled studies did suggest 3. Bugiardini R, et al. Effects of iloprost, a stable prostacyclin analog, on an effect, 6 firm conclusions are difficult.