An inhaled prostacyclin for high blood pressure in the lung arteries
Iloprost
An inhaled prostacyclin that widens the lung arteries, given by frequent nebuliser sessions through the day for pulmonary arterial hypertension.
What is Iloprost?
Iloprost is a prostacyclin medicine used to treat pulmonary arterial hypertension, which is high blood pressure in the arteries of the lungs. It relaxes and widens the lung arteries to ease breathlessness and help you do more. For lung pressure it is breathed in as a mist through a nebuliser, and because it does not last very long it has to be taken as several inhalations spread across the day. Common effects include flushing, jaw ache and a drop in blood pressure. It is started and supervised by a specialist pulmonary hypertension centre. A different infusion form is sometimes used for severe Raynaud's.
Education and reference only. This is a plain-language guide to Iloprost — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Iloprost is a man-made version of prostacyclin, a natural substance that relaxes blood vessels and stops blood clotting too readily. For pulmonary arterial hypertension — a serious condition where the pressure in the lung arteries is too high — it is breathed in as a fine mist using a special nebuliser. Because its effect is short-lived, it is taken as several inhalation sessions during the day. It is a specialist medicine prescribed through pulmonary hypertension services in the UK. An infusion form is also used in some hospitals for severe Raynaud's phenomenon.
How it works
Prostacyclin normally helps keep blood vessels relaxed and open. In pulmonary arterial hypertension there is too little of it, so the lung arteries stay narrowed and tight. Iloprost replaces this action: breathed in, it relaxes and widens the lung arteries, lowering the pressure the heart pumps against and easing breathlessness. Because the inhaled effect wears off after a while, repeated sessions through the day are needed to keep the lung arteries open.
Company & origin
Originated / developed by: Bayer (originator).
An inhaled prostacyclin medicine used in the UK by specialist centres to treat pulmonary arterial hypertension.
Practical use
How to take Iloprost
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Breathe it in through the specific nebuliser device your team provides, exactly as you have been trained.
- Take the inhalation sessions spread through the day as prescribed, since the effect is short-lived and needs repeating.
- Sit or stand up slowly after a session if you feel light-headed, as it can lower your blood pressure.
- Keep the device clean and maintained as instructed, so each session delivers the medicine properly.
- Do not stop the treatment suddenly without specialist advice, and report fainting, severe dizziness or worsening breathlessness.
Weighing it up
Advantages & disadvantages of Iloprost
Advantages
- Delivered straight to the lungs by inhalation, focusing its action where it is needed.
- Can ease breathlessness and improve exercise capacity in pulmonary arterial hypertension.
- Avoids the need for a permanent infusion line that some other prostacyclins require.
Disadvantages
- Needs many inhalation sessions spread across the day because the effect is short-lived.
- Commonly causes flushing, jaw ache, headache and a fall in blood pressure with dizziness.
- Relies on correct use and upkeep of the nebuliser device.
Practical use
Good to know
Iloprost is a specialist medicine, always started and supervised by a pulmonary hypertension centre, who will train you to use the nebuliser correctly. The main practical point is the routine: the inhaled effect is short, so you may need many sessions spread across the day, which takes commitment and planning. Common effects come from its blood-vessel-widening action — flushing, headache, jaw or throat ache and a fall in blood pressure that can cause dizziness — and it can cause coughing as it is inhaled. It should not be stopped abruptly without advice. A separate intravenous infusion form of iloprost is sometimes used in hospital for severe Raynaud's, which is a different use from the inhaled lung treatment.
Who should not take it / use with caution
- People with very low blood pressure or certain unstable heart conditions are not suitable for it.
- It is avoided in people at high risk of bleeding, because it can affect how blood clots.
- It is used with caution in those with certain lung conditions where inhalation may trigger tightening of the airways.
Monitoring
- Review of blood pressure and any dizziness or fainting after sessions.
- Checking inhaler technique and that the nebuliser is being used and maintained correctly.
- Regular specialist review of breathlessness, walking distance and overall response.
Side effects
- Flushing, headache and jaw or throat ache are common.
- Low blood pressure with dizziness or light-headedness, and coughing during inhalation.
- Less often, fainting, palpitations or, rarely, increased bleeding tendency.
Key interactions
- Can add to the blood-pressure-lowering effect of other medicines, increasing the risk of dizziness.
- May add to the effect of blood-thinning and anti-platelet medicines, raising bleeding risk.
- Used alongside other pulmonary hypertension medicines under specialist supervision.
Available as: Solution breathed in through a nebuliser; a separate solution for intravenous infusion is used in some hospital settings.
Answers
Iloprost: frequently asked questions
Why do I have to inhale it so many times a day?
The inhaled effect is short-lived, so several sessions are spread across the day to keep the lung arteries relaxed and open.
Why do I feel flushed or get jaw ache?
These come from iloprost widening blood vessels and are common; they often settle, but tell your team if they are troublesome.
Could it make me dizzy?
Yes, it can lower blood pressure, so you may feel light-headed; stand up slowly and report severe dizziness or fainting to your team.
Is the inhaled form the same as the drip used for Raynaud's?
They are the same medicine but used differently; the inhaled form treats lung pressure, while a hospital infusion form is sometimes used for severe Raynaud's.
Can my GP start this?
No, it is a specialist medicine started and supervised by a pulmonary hypertension centre, which also trains you to use the nebuliser.
Authoritative sources
- BNF
- NICE CKS
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