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Prostacyclin analogue (vasodilator) Pregnancy: Avoid — limited data. Use only if benefit clearly outweighs risk.

Iloprost (IV/Nebulised)

Brand names: Ilomedine (IV), Ventavis (nebulised)

Adult dose

Dose: Critical limb ischaemia (IV): 0.5–2 nanograms/kg/min IV infusion for 6 hours/day; PAH (nebulised): 2.5–5 mcg per inhalation 6–9 times daily
Route: IV infusion or nebulised inhalation
Frequency: IV: daily infusion for 3–4 weeks; Nebulised: 6–9 times/day
Max: 2 nanograms/kg/min IV
Critical limb ischaemia / Raynaud's: 0.5–2 ng/kg/min IV over 6 hours daily for 3–4 weeks. PAH (Ventavis nebuliser): start 2.5 mcg per inhalation, 6–9 times daily while awake. Each inhalation session: 4–10 minutes.

Paediatric dose

Route: IV or nebulised
Frequency: Specialist guidance
Max: Specialist guidance
Specialist paediatric use only for pulmonary hypertension or severe Raynaud's. Very limited data in children.

Dose adjustments

Renal

Use with caution in severe renal impairment.

Hepatic

Reduce infusion rate in hepatic impairment (reduced clearance).

Clinical pearls

  • Critical limb ischaemia: used when revascularisation not possible — reduces rest pain, promotes ulcer healing
  • Systemic PAH: epoprostenol (IV) or selexipag preferred; iloprost nebulised is an option
  • Scleroderma-associated Raynaud's: IV iloprost course reduces frequency/severity of attacks
  • Monitor BP closely during IV infusion
  • Nebulised iloprost: pulmonary vasodilation without systemic effects — specialist centre use

Contraindications

  • Severe heart failure or coronary artery disease (unstable)
  • Pulmonary oedema
  • Active peptic ulcer
  • Recent haemorrhagic stroke

Side effects

  • Flushing
  • Headache
  • Hypotension
  • Jaw pain and myalgia
  • GI upset
  • Bronchospasm (nebulised)

Interactions

  • Antiplatelet drugs and anticoagulants — increased bleeding risk
  • Antihypertensives — additive hypotension

Monitoring

  • Blood pressure during infusion
  • Heart rate
  • Signs of bleeding
  • PAH: exercise tolerance, 6MWT

Reference: BNFc; BNF; EULAR Scleroderma Guidelines; ESC PAH Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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