Iloprost

Iloprost is a calcium channel blocker, a medicine used to treat high blood pressure (hypertension) and angina (pain in the heart caused when the blood supply to the heart's muscles is restricted). Calcium channel blockers work by relaxing your artery wall muscles. This widens your arteries and reduces your blood pressure.

Iloprost is inhaled through a nebuliser. This is a device that turns the liquid medicine into a mist you breathe in to your lungs. You may need to take iloprost six to nine times a day. Each dose can take up to 10 minutes to inhale.

You will need to stay in hospital for up to three days, so that you can be trained in using the nebuliser, and to monitor your response. After this, you should be able to return home and continue taking the medicine.

How long you need to take iloprost for will depend on your condition. You may need to continue taking it, possibly alongside other treatments, until your condition worsens and you need epoprostenol.

Iloprost may not be suitable if:

  • you have a peptic ulcer
  • you have recently had a heart attack or stroke
  • your pulmonary hypertension is caused by pulmonary veno-occlusive disease (a rare condition that causes high blood pressure in the lungs)
  • your pulmonary hypertension is unstable, with advanced right heart failure

Iloprost is sometimes used to treat very severe cases of frostbite or circulation. It works by widening the blood vessels that supply blood to the affected body part. It may be prescribed if you have ulcers of the fingers resulting from systemic sclerosis (scleroderma) or related conditions. They may also be used for severe Raynaud's phenomenon or when there is gangrene due to very poor circulation.

When severe frostbite threatens the loss of a limb, finger or toe, a person should be considered for treatment with tPA or iloprost within 24 hours of the injury occurring. Experience has shown that treatment given within this timeframe has the best outcomes in terms of saving the affected body part. However, these treatments could still be considered as an option within an experienced unit after 24 hours.

If some of the tissue of the affected body part has died (a condition known as gangrene), it will need to be removed. The procedure to remove dead tissue is called debridement. In the most serious cases, an entire part of the body, such as the fingers or toes, may need to be removed (amputated).

A decision to perform debridement or amputation is usually delayed for several weeks, as often what appears to be dead tissue can heal and recover over time.

Iloprost is a man-made form of a substance called prostacyclin which is produced naturally in the body. Iloprost is used to improve blood flow in people with severe circulatory problems.

Epoprostenol is another form of prostacyclin, used by some doctors for the same reasons and in the same way.

Iloprost also improves the circulation of the blood by:

  • reducing clumping of the red cells in the blood, which reduces the tendency of the blood to clot
  • helping to prevent or repair damage to blood vessels. Iloprost usually starts to work immediately, although it can sometimes take up to six weeks.
  • If you've been suffering with very cold hands or feet they may feel warmer straight away. Ulcers may begin to improve within a few days. Iloprost's beneficial effects may carry on for weeks and sometimes even months after the infusion. Usually, iloprost is prescribed if other drugs such as nifedipine haven't worked for you. Your doctor will discuss other treatment options with you if need be.

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