Iloprost headache, flushing

Beraprost is a stable, orally active analogue of PGI2. It has been tested in patients with intermittent claudication in a randomized, placebo-controlled trial (1). Beraprost improved walking distance more often than placebo. It also reduced the incidence of critical cardiovascular events, but the trial was not powered for statistical validation of this effect. As with iloprost, headache and flushing were the most common adverse effects. 

Comparative studies Studies of prostanoids in intermittent claudication have yielded inconsistent results. In a multicenter comparison of three doses of oral iloprost, pentoxifylline, and placebo, conducted in 1998-1999 but published only in 2008, oral iloprost did not improve exercise performance or quality of Ufe pi "]. Serious adverse events did not differ among the groups and neither did any specific cardiovascular events. However, oral iloprost was poorly tolerated and therapy was often interrupted because of headache, flushing, nausea, or diarrhea. 

There has been a sequential comparison of inhaled nitric oxide 40 ppm with aerosolized iloprost 14— 17 micrograms in 35 adults with primary pulmonary hypertension (125). Five of the patients had minor headache and facial flushing during inhalation of iloprost, but these symptoms were short-lived and abated a few minutes after the inhalation ended. One patient had mild jaw pain after aerosolized iloprost, but again this was shortlived. There was an unexpected increase in pulmonary artery pressure in 10 patients and vascular resistance in six patients who received nitric oxide. The authors were uncertain of the cause of this increase, as nitric oxide generally behaves as a vasodilator, but they noted that... 

Iloprost is mainly used in patients with chronic critical leg ischemia due to atherosclerosis or Buerger s disease. Episodic digital ischemia in patients with systemic sclerosis or related disorders is another use. The most frequently observed adverse effects, facial flushing and headache, are caused by profound vasodilatation. 

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