Ventavis (iloprost tromethamine)

No dosing information is available for this tab.

No dosing information is available for this tab.

No dosing information is available for this tab.

Iloprost is metabolized principally via beta-oxidation of the carboxyl side chain. Its metabolite, tetranor-iloprost, is considered to be inactive. Metabolism via cytochrome P-450 (CYP) isoenzymes is minor.

During clinical trials, iloprost was used concomitantly with anticoagulants, diuretics, cardiac glycosides, calcium-channel blocking agents, analgesics, antipyretics, nonsteroidal anti-inflammatory agents, corticosteroids, and other drugs.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

Moderate Interaction: Assess the risk to the patient and take action as needed.

Selected Antihypertensives And Vasodilators/Apomorphine

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Apomorphine causes dose-dependent decreases in blood pressure. Concurrent use with antihypertensive agents may result in additive effects on blood pressure.(1)

CLINICAL EFFECTS: Concurrent use of antihypertensives and apomorphine may result in orthostatic hypotension with or without dizziness, nausea, or syncope.(1)

PREDISPOSING FACTORS: The risk of orthostatic hypotension may be increased during dose escalation of apomorphine and in patients with renal or hepatic impairment.(1)

PATIENT MANAGEMENT: Patients receiving concurrent therapy should be monitored for hypotension. Counsel patients about the risk of orthostatic hypotension.(1)

DISCUSSION: Healthy volunteers who took sublingual nitroglycerin (0.4 mg) concomitantly with apomorphine experienced a mean largest decrease in supine systolic blood pressure (SBP) of 9.7 mm Hg and in supine diastolic blood pressure (DBP) of 9.3 mm Hg, and a mean largest decrease in standing SBP and DBP of 14.3 mm Hg and 13.5 mm Hg, respectively. The maximum decrease in SBP and DBP was 65 mm Hg and 43 mm Hg, respectively. When apomorphine was taken alone, the mean largest decrease in supine SBP and DBP was 6.1 mm Hg and 7.3 mm Hg, respectively, and in standing SBP and DBP was 6.7 mm Hg and 8.4 mm Hg, respectively.(1)

Selected Antihypertensives/Tizanidine

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Tizanidine is an alpha-2 agonist. Concurrent use with antihypertensive agents may result in additive effects on blood pressure.(1)

CLINICAL EFFECTS: Concurrent use of antihypertensives and tizanidine may result in hypotension.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Patients receiving concurrent therapy should be monitored for hypotension. The risk of hypotension may be decreased by careful titration of tizanidine dosages and monitoring for hypotension prior to dose advancement. Counsel patients about the risk of orthostatic hypotension.(1)

DISCUSSION: Severe hypotension has been reported following the addition of tizanidine to existing lisinopril therapy.(2-4)

*None.

• Lactation

• Hypotension
• Pulmonary edema

• Bronchospastic pulmonary disease
• Chronic obstructive pulmonary disease

Adverse effects reported at least 3% more frequently with iloprost than with placebo include vasodilation (flushing), cough, headache, trismus, insomnia, nausea, hypotension, vomiting, increased alkaline phosphatase, flu syndrome, back pain, tongue pain, palpitations, syncope, increased gamma-glutamyl transferase (GGT), muscle cramps, hemoptysis, and pneumonia.

More Frequent

• Abnormal hepatic function tests

Less Frequent

• Pneumonia

Rare or Very Rare

• Bronchospastic pulmonary disease
• Chest pain
• Chronic heart failure
• Dyspnea
• Hypersensitivity drug reaction
• Paroxysmal supraventricular tachycardia
• Peripheral edema
• Renal failure
• Supraventricular tachycardia
• Thrombocytopenic disorder

More Frequent

• Back pain
• Cough
• Cramps
• Flu-like symptoms
• Headache disorder
• Hypotension
• Insomnia
• Nausea
• Palpitations
• Syncope
• Trismus
• Vasodilation of blood vessels
• Vomiting

Less Frequent

• Hemoptysis
• Sore tongue

Rare or Very Rare

• Diarrhea
• Dizziness
• Dysgeusia
• Epistaxis
• Mouth irritation
• Nasal congestion
• Skin rash

No enhanced messaging available.

Safety and efficacy of iloprost have not been established in pediatric patients.

A drug-associated risk of adverse maternal or fetal outcomes has not been demonstrated in limited case reports and case series of iloprost. Available animal data are conflicting. Untreated pulmonary arterial hypertension (PAH) in pregnancy increases the risk for maternal heart failure, stroke and death, miscarriage, preterm delivery, low birthweight infants, and stillbirth.

Iloprost is distributed into milk in rats; it is not known whether the drug is distributed into human milk. When a drug is present in animal milk, it is likely the drug will be present in human milk. Because of the potential for severe adverse effects in nursing infants, advise women not to breastfeed during treatment.

Initial dosage in geriatric patients should be selected with caution (usually at the low end of the dosage range) and titrated carefully because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.

Clinical studies of iloprost did not include sufficient numbers of patients 65 years of age and older to determine whether geriatric patients respond differently than younger patients. In general, dosage should be titrated carefully in geriatric patients. The greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly should be considered.