Pulmonary Arterial Hypertension Pregnancy: Women with pulmonary hypertension should avoid pregnancy as it may lead to life-threatening exacerbation of the disease, and women of childbearing potential should use effective contraception during treatment. There is a limited amount of data from use in pregnant women and animal studies have shown reproductive effects; use during pregnancy may be considered only after careful benefit-risk evaluation in women who choose to continue their pregnancy. It is not known whether iloprost or its metabolites are excreted in human breast milk; a potential risk to the breast-feeding child cannot be excluded and it is preferable to avoid breast-feeding during therapy.

Iloprost (Inhaled)

Brand names: Ventavis

An inhaled prostacyclin analogue delivered by nebuliser for pulmonary arterial hypertension, providing relatively selective pulmonary vasodilation. This is the inhaled formulation, distinct from intravenous prostacyclin therapies.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Dose per inhalation session: at initiation of treatment the first inhaled dose should be 2.5 micrograms iloprost as delivered at the mouthpiece of the nebuliser; if this is well tolerated the dose should be increased to 5 micrograms and maintained at that dose. If the 5 microgram dose is poorly tolerated, reduce back to 2.5 micrograms.

Route: Inhalation by nebulisation, using a suitable inhalation device — Breelib, I-Neb AAD or Venta-Neb. Patients stabilised on one nebuliser should not switch to another without supervision by the treating physician.

Frequency: The dose per inhalation session should be administered 6 to 9 times per day according to individual need and tolerability

Iloprost should only be initiated and monitored by a physician experienced in the treatment of pulmonary hypertension. Duration of treatment depends on clinical status and is left to the physician's discretion; if patients deteriorate on this treatment, intravenous prostacyclin treatment should be considered. HEPATIC IMPAIRMENT: elimination is reduced — to avoid accumulation over the day, initially give 2.5 micrograms (using iloprost 10 micrograms/mL) with dosing intervals of 3-4 hours, corresponding to administration a maximum of 6 times per day; intervals may then be shortened cautiously based on individual tolerability. If a dose up to 5 micrograms is indicated, again start with 3-4 hour intervals and shorten according to tolerability. Device notes: with Breelib, 1 mL of iloprost 10 micrograms/mL delivers 2.5 micrograms at the mouthpiece and a session lasts approximately 3 minutes — if tolerated the dose is increased using a 20 micrograms/mL presentation; with I-Neb AAD, the 2.5 microgram dose uses the red-latch medication chamber with the red control disc (about 3.2 minutes) and the 5 microgram dose the purple-latch chamber with the purple control disc (about 6.5 minutes), using one 1 mL ampoule per session; with Venta-Neb, two 1 mL ampoules are used per session, programme P2 delivering 2.5 micrograms (10 inhalation cycles, about 4 minutes) and programme P1 delivering 5 micrograms (25 inhalation cycles, about 8 minutes), with the green baffle plate fitted. Efficacy and tolerability with other nebulising systems have not been established. Do not initiate iloprost in patients with systolic blood pressure less than 85 mmHg; check blood pressure while initiating treatment (section 4.4). Paediatric: safety and efficacy of iloprost in children aged up to 18 years have not been established and no data from controlled clinical trials are available. Keep the room well ventilated to minimise accidental exposure. Section 4.5 was not fetched; the interactions listed below come from sections 4.4 and 4.8 of this SPC. No US (openFDA) record was fetched for this product.

Dose adjustments

Renal

No dose adaptation is needed in patients with a creatinine clearance >30 mL/min (Cockcroft and Gault). Patients with a creatinine clearance of <=30 mL/min were not investigated in the clinical trials. Data with intravenous iloprost indicate reduced elimination in patients with renal failure requiring dialysis, so the same dosing recommendations as for hepatic impairment apply (initial 2.5 microgram doses at 3-4 hour intervals, maximum 6 times per day, then shorten intervals cautiously).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Conditions where the effects of iloprost on platelets might increase the risk of haemorrhage (e.g. active peptic ulcers, trauma, intracranial haemorrhage)
Severe coronary heart disease or unstable angina
Myocardial infarction within the last six months
Decompensated cardiac failure if not under close medical supervision, or severe arrhythmias
Cerebrovascular events (e.g. transient ischaemic attack, stroke) within the last 3 months
Pulmonary hypertension due to venous occlusive disease
Congenital or acquired valvular defects with clinically relevant myocardial function disorders not related to pulmonary hypertension

Side effects

Vasodilatation including hypotension (very common, >=20%) and flushing
Headache (very common)
Cough (very common), with chest discomfort/chest pain, dyspnoea and pharyngolaryngeal pain
Bleeding events (very common; mostly epistaxis and haemoptysis, with fatal cerebral and intracranial haemorrhage reported)
Bronchospasm/wheezing and syncope (the most serious reactions were hypotension, bleeding events and bronchospasm)
Jaw pain/trismus, nausea and peripheral oedema

Interactions

Medicinal products known to reduce blood pressure — care should be taken to avoid further hypotension; concomitant conditions or medicines may increase the risk of hypotension and syncope (section 4.4)
Inhibitors of platelet aggregation or anticoagulants given concomitantly may increase the risk of bleeding (section 4.8)

Clinical monograph

How it works

Iloprost mimics prostacyclin, stimulating prostacyclin receptors to relax pulmonary vascular smooth muscle and inhibit platelet aggregation; inhalation targets ventilated lung regions and limits systemic effects.

Prescribing in practice

Systemic hypotension is the key hazard — withhold or do not initiate if the patient is already hypotensive, and avoid in pulmonary veno-occlusive disease where it can precipitate pulmonary oedema.
Multiple inhalations are needed across the waking day because each dose is short-acting, so adherence and a reliable nebuliser are essential.
Use cautiously with other vasodilators and antiplatelet or anticoagulant agents owing to additive hypotension and bleeding risk.

Monitoring

Monitor blood pressure, oxygen saturation and functional status, and watch for jaw pain, flushing, cough or syncope around dosing.

Counselling the patient

Take each nebulised dose as scheduled through the day and do not skip — its effect wears off quickly.
Tell your team if you feel faint, dizzy or develop worsening breathlessness.

Evidence & guidelines

Inhaled iloprost is an established option for pulmonary arterial hypertension within specialist pulmonary hypertension services per NICE-commissioned pathways.

Reference: AIR trial Lancet 2002; 360(9337):896-901; ESC/ERS PAH Guidelines 2022; NICE TA459; MHRA SPC Ventavis; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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