How to take Iloprost
Iloprost can be 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 can also be given through a drip (infusion) into your arm, usually continuously for about six hours a day for 3–5 days in a row in hospital or a clinic. It can sometimes be given continuously over 24 hours. In some hospitals you stay on the ward for five days and in others you attend the day-case unit during the day and go home in the evenings.
The infusion will be started at a low dose and then increased gradually to make sure you can tolerate the higher doses. If you develop side-effects, your dose will generally be reduced again. The rate at which iloprost is given depends on your weight, but can also be adjusted if you have side-effects.
Sometimes longer-term or continuous prostacyclin is prescribed, for example in people with pulmonary hypertension (a condition sometimes associated with scleroderma that leads to raised pressure in the arteries supplying the lungs).
Possible risks and side-effects
The main side-effects of iloprost are facial flushing, headaches and a fall in blood pressure – therefore your blood pressure will be carefully monitored during your treatment.
Less common side-effects include:
- nausea (feeling sick)
- muscle cramps
- pain in the jaw.
Paracetamol and an anti-sickness drug can be given if you experience side-effects. All side-effects disappear very quickly once the iloprost infusion is stopped or reduced.
Taking other medicines alongside iloprost
You can take all your usual medications before and after a course of iloprost. However, during a course of iloprost, your doctor will probably recommend that you don't take certain other medications which also widen the blood
vessels or lower blood pressure.
When you go to the hospital on the first day, take a list of all your medications with you. Your doctor will tell you whether you should leave out any medications on the days when you're having an infusion.
Iloprost doesn't affect vaccinations, so you can have them before or after a course of iloprost treatment. In the unlikely event that you need a vaccination during a course of iloprost, your specialist will advise you.
There's no particular reason to avoid alcohol before or after a course of iloprost treatment. However, in the evenings after your infusions you should limit your alcohol intake as it may make the side-effects of iloprost worse.
Fertility, pregnancy and breastfeeding
We don't know whether iloprost has any effect on fertility. Current guidelines state that iloprost will only be prescribed to pregnant women in special circumstances if their disease is severe. If you're pregnant or planning to start a family you should tell your doctor before you start the treatment.
There is no research on use of this drug in breastfeeding so it's probably best avoided while on iloprost.
If you've had cold hands or feet, iloprost can improve these symptoms.
A five-day course of iloprost may be prescribed for you every year, often at the beginning of winter, though it may be given more often if needed. When treatment is successful, improvements to the circulation can be effective immediately. If you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or specialist pharmacist.
Information sourced from the NHS, Mayo Clinic and Arthritis Research UK.