Iloprost (Raynaud's / Systemic Sclerosis)

How it works

Iloprost is a synthetic prostacyclin (PGI2) analogue that produces vasodilatation and inhibits platelet aggregation, improving peripheral and digital blood flow.

Prescribing in practice

• Dose-related hypotension, flushing, headache, nausea and jaw or muscle pain are common during infusion, so the rate is titrated to tolerability with blood pressure monitoring.
• It is contraindicated in conditions where vasodilatation or its antiplatelet effect would be hazardous, such as decompensated heart failure, recent myocardial infarction or active bleeding.
• Caution and rate review are needed with antihypertensives, anticoagulants and antiplatelets owing to additive effects.

Monitoring

Monitor blood pressure and heart rate closely throughout each infusion and titrate the rate against vasodilatory side effects as set out in the SPC.

Counselling the patient

• Headache and flushing during the infusion are expected and usually settle as the rate is adjusted.
• Tell the nurse if you feel faint, dizzy or unwell during treatment.
• Several daily infusions may be needed for a full course.

Evidence & guidelines

Controlled trials support intravenous iloprost for healing digital ulcers and reducing the frequency and severity of systemic-sclerosis-associated Raynaud's attacks.