Inhaled iloprost

Idzko M. Hammad H, van Nimwegen M, Kool M, Vos N, Hoogsteden HC, Lambrecht BN Inhaled iloprost suppresses the cardinal features of asthma via inhibition of airway dendritic cell function. J Clin Invest 2007 II7 464-472. 

Absorption-The absolute bioavailability of inhaled iloprost has not been determined. Iloprost was generally not detectable in the plasma 30 minutes to 1 hour after inhalation. 

Puimonary edema If signs of pulmonary edema occur when inhaled iloprost is administered in patients with pulmonary hypertension, stop the treatment immediately. This may be a sign of pulmonary venous hypotension. 

Inhalation of aerosolized iloprost is being tested in patients with severe primary or secondary pulmonary hypertension refractory to conventional therapy. The aim is to produce predominantly pulmonary vasodilatation without significant systemic effects. In an uncontrolled series of 19 patients, the most common adverse effects of inhaled iloprost were coughing, nausea, edema, and thoracic pain (4). In most patients, these effects were transient and rarely required a change in therapy. 

Olschewski H, Ghofrani HA, Schmehl T, Winkler J, Wilkens H, Hoper MM, Behr J, Kleber FX, Seeger W. Inhaled iloprost to treat severe pulmonary hypertension. An uncontrolled trial. German PPH Study Group. Ann Intern Med 2000 132(6) 435 13. 

Olschewski, H., Rohde, B., Behr, J., et al. (2003), Pharmacodynamics and pharmacokinetics of inhaled iloprost, aerosolized by three different devices, in severe pulmonary hypertension, Chest, 124,1294—1304. 

There are experiences of ambulatory treatment of patients with pulmonary hypertension, with inhaled nitric oxide and with prostaglandins, in both cases using an ambulatory delivery system. In our center we have an outpatient treatment program of pulmonary hypertension with inhaled iloprost leading in some patients to significant improvement in pulmonary hypertension and in the quality of life with no adverse effects. 

Finally, a comprehensive hemodynamic evaluation in IPAH patients should include assessment of pulmonary vasoreactivity with inhaled nitric oxide (10-40 ppm), inhaled iloprost, IV epoprostenol, or adenosine in patients with precapillary hypertension. If with these treatments mPAP decreases by 10 mm Hg to levels <40 mm Hg, IPAH patients are considered responders. This denotes a small but very important population (<15% of IPAH patients) with significantly improved outcomes when treated with high doses of calcium channel blockers (29,30). For the select patients who are deemed responders and are subsequently treated with calcium antagonists, close follow-up to confirm a sustained hemodynamic improvement is essential. 

McLaughlin VV, Oudiz RJ, Frost A, et al. Randomized study of adding inhaled iloprost to existing bosentan in pulmonary arterial hypertension. Am J Respir Crit Care Med 2006 174 1257-63. 

Feito RM, Floristan U, de Lucas LR. A curious but non-serious local side effect of inhaled iloprost sudden linear erythematous facial rash. Clin Exp Dermatol 2009 34(8) el014. 

Novel agents with potential antifibrotic properties have theoretical value but have not yet been evaluated in IPF (discussed in detail elsewhere) (59,60,179). Agents that are currently being studied in IPF include imatinib mesylate, siro-limus, captopril, inhaled iloprost, and other inhibitors of fibrotic growth factors... 

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