The most commonly observed adverse events (≥ 10%) are headache, flushing, nausea, vomiting and hyperhidrosis. These undesirable effects are likely to occur during the dose titration and can be used to identify the best tolerable dose for the individual patient as they generally resolve following dose reduction.
Management of adverse reactions
- hypotension, tachycardia, vagal reaction with bradycardia: stop infusion and consider IV fluids, can be restarted at half the previous rate
- facial flushing, headache, nausea/vomiting, abdominal cramps or diarrhoea: reduce rate by 0.5nanogram/kg/min if intolerable, antiemetics and paracetamol can be prescribed
- fever, apathy, limb pain: treat conservatively, paracetamol and reassurance
Iloprost may increase the anti-hypertensive activity of β- blockers, calcium antagonists, vasodilators and ACE inhibitors. In case of significant hypotension, this can be corrected by dose reduction of iloprost. Alternatively, while there is little evidence to support withholding these drugs prior to the start of the infusion, in practice this is something that may be done on a cases by case basis to improve tolerability.
Because iloprost inhibits platelet aggregation, concomitant use of anticoagulant or antiplatelets may increase the risk of bleeding. The possible increase in haemorrhagic risk should be taken into account by maintaining close clinical monitoring. Should clinically significant bleeding occur, iloprost administration should be stopped.