Iloprost (Inhaled)

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.