Prostacyclin Analogue
Pregnancy: C
Iloprost (IV/Inhaled)
Brand names: Ilomedin, Ventavis
Adult dose
Dose: IV: 0.5–2 nanograms/kg/min × 6h daily × 5–28 days; Inhaled: 2.5–5 micrograms 6–9 times daily
Route: IV infusion or inhalation
Frequency: daily (IV) or 6–9 times daily (inhaled)
Max: 2 nanograms/kg/min IV
IV form for critical limb ischaemia (Raynaud's, systemic sclerosis, thromboangiitis obliterans); inhaled form for PAH
Paediatric dose
Route: IV
Frequency: continuous infusion
Max: 2 nanograms/kg/min
Concentration: 20 micrograms/mL or 100 micrograms/mL nanograms/min/ml
Used in paediatric PAH under specialist guidance only
Dose adjustments
Renal
No dose adjustment required
Hepatic
Use with caution in hepatic impairment
Clinical pearls
- Analogue of prostacyclin (PGI2) — vasodilates, inhibits platelet aggregation, antiproliferative
- Useful in systemic sclerosis-related digital ulcers — reduces healing time and new ulcer formation
- Inhaled form allows pulmonary selectivity — reduces systemic hypotension vs. IV epoprostenol
Contraindications
- Severe coronary artery disease
- Unstable angina
- Recent MI (<6 months)
- Severe arrhythmias
- Pulmonary veno-occlusive disease (for inhaled form)
Side effects
- Flushing
- Headache
- Hypotension
- Jaw pain
- Nausea
- Cough (inhaled)
Interactions
- Anticoagulants (increased bleeding)
- Antihypertensives (hypotension)
- Vasodilators
Monitoring
- Blood pressure
- Heart rate
- Signs of digital ulcer healing
- Pulmonary function (inhaled form)
Reference: BNFc; BNF 86; EAU/BSR guidelines; ESOC Raynaud's guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.