China
Africa
Explore chapters and articles related to this topic
The Patient with Non-Group 2 Pulmonary Hypertension
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Sophia Anastasia Mouratoglou, George Giannakoulas
Iloprost is a prostanoid analogue administered either IV or by inhalation. The latter is usually well tolerated, and the starting dose is 15 μg/day up-titrated to the target of 30 μg/day, divided into six equal doses. Iloprost has improved WHO functional class combined by improvement of 6-min walk distance, as well as hemodynamics and quality of life when compared with placebo in a randomized, controlled clinical trial.66 Although syncope occurred with similar frequency in the two groups, this side effect was more frequently rated as serious in the Iloprost group. However, syncope was not associated with clinical deterioration in that trial.66 The use of iloprost is associated with jaw pain, flushing, and cough, sometimes limiting patient adherence.
Pulmonary Hypertension in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Typical indications for starting prostaglandin treatment include worsening functional class (WHO functional class III or IV) and deteriorating right ventricular function. Earlier introduction of targeted therapy has also been described, with daily nebulized iloprost being administered in the first trimester in patients in WHO functional class II [9]. In patients who are deteriorating, have worsening functional class, or have inadequate clinical response, treatment should be escalated with rapid conversion to parenteral forms (such as IV epoprostenol) or with addition of a phosphodiesterase 5-inhibitor [9,17]. Continuous IV epoprostenol use is expensive and cumbersome, as it requires an indwelling central venous catheter and continuous infusion pump and requires daily preparation [3]. However, it has been shown to improve cardiac indices, functional class, and is the only therapy for PAH that has been shown to prolong survival [3,5]. A meta-analysis of three randomized control trials of epoprostenol showed a risk reduction for mortality of 70%, and long-term efficacy has also been shown [3,18,19].
Management of scleroderma
Published in Aparna Palit, Arun C. Inamadar, Systemic Sclerosis, 2019
Prostanoids, PDE-5 inhibitors, calcium channel blockers, and endothelin receptor antagonists (ERBs) have been recommended in the management of digital ulcers in SSc. Intravenous iloprost provides better efficacy as compared to treprostinil. However, considering the risk of side effects and the need for hospitalization, it is suggested that intravenous iloprost be administered in patients not responding to oral treatment. Intravenous iloprost combined with oral nifedipine is also beneficial. Selective PDE-5 inhibitors (tadalafil, sildenafil) are also found to be efficacious in healing and improvement of digital ulcers. The ERBs, like bosentan, are recommended in cases refractory to the above measures, especially in patients with multiple ulcers.11 Bosentan helps in the prevention of new ulcers rather than in the healing of existing ulcers.10
Pharmacological management of digital ulcers in systemic sclerosis - what is new?
Published in Expert Opinion on Pharmacotherapy, 2023
Ariane L. Herrick, Mariana Philobos
IV prostanoid therapy is well established in the treatment of SSc-related DUs, and IV prostanoids ‘in particular iloprost’ are included in the EULAR recommendations for the treatment of active DU in patients with SSc [33], as well as in the BSR guideline [38]. Iloprost, a prostacylin analogue, is most widely prescribed, preventing DUs and promoting DU healing [53,54]. Iloprost is thought to exert beneficial effects not only through vasodilation but also through its anti-platelet effects, and there are probably other mechanisms of action that may explain the prolonged clinical benefit, which many patients experience, including stabilization of endothelial cell adherens junctions, normalization of angiogenesis, and inhibition of endothelial-to-mesenchymal transition [55].
Evidence for increase in finger blood flow, evaluated by laser Doppler flowmetry, following iloprost infusion in patients with systemic sclerosis: a week-long observational longitudinal study
Published in Scandinavian Journal of Rheumatology, 2018
C Rotondo, M Nivuori, A Chialà, E Praino, M Matucci Cerinic, M Cutolo, G Lapadula, F Iannone
In the occlusive test (Figure 1B), a mechanical stress of 200 mmHg pressure was applied by means of an air bracelet taped on the left arm to occlude the brachial artery. This test explores the NO response following a mechanical stress. After a 5 min baseline resting period, 200 mmHg loading was applied for 3 min, and a 12 min recovery period was recorded. During the occlusive test, the resting flow (RF) (the mean value in the resting period) and biological zero (BZ) (the mean value of the flow in the loading period) were evaluated by LDF. After the loading period, the following variables were evaluated: the peak flow (PF) (the maximum value of the flow after the mechanical stress), the post-occlusion hyperaemic gain flow (po-GF) (the percentage variation between RF and PF), the maximum degree gain flow (md-GF) (the percentage variation between BZ and PF), the recovery time (TR) (the time to reach the value of RF after the occlusion stress), the peak time (TM) (the time to reach PF after the pressure relief), time to reach the mean PF (TH1), time to reach the mean of the hyperaemic area (TH2), and the hyperaemic area (AH) (the area under the curve after the pressure relief in which the flow is higher than RF). Furthermore, we considered the ratio between PF and RF (r-PRF) to evaluate the NO-dependent vasodilation. All the flows were adjusted for BZ. The T0 and T3 heating and occlusive tests were assessed between 08.00 and 09.00 h. The T1 tests were assessed immediately at the end of i.v. iloprost infusion without a pause, and T2 tests were assessed 24 h after the last i.v. iloprost infusion. The occlusive test was performed 15 min after the end of the heating test.
The role of Iloprost on bone edema and osteonecrosis: Safety and clinical results
Published in Expert Opinion on Drug Safety, 2018
Ippokratis Pountos, Peter V Giannoudis
Iloprost is commercially available and licensed for the treatment of arterial pulmonary hypertension. However, the off-license uses are significant. It is used in the management of thromboangiitis obliterans and scleroderma for its antithrombotic, vasodilatative, and antiproliferative effects [38]. It was found to prevent renal dysfunction among transplant patients [39]. Furthermore, it has been used in the management of limb ischemia, Raynaud’s disease, and systemic sclerosis [40–42].