Administering iloprost for severe Raynaud's phenomenon

Abstract

T topic of this month’s Calculation Skills is iloprost, a synthetic analogue of prostacyclin, which is known to dilate pulmonary and arterial vascular beds. Iloprost has been used via a nebulizer to treat pulmonary hypertension and by intravenous (IV) infusion to treat other diseases where the constriction of blood vessels interferes with blood supply to the tissues, such as scleroderma and Raynaud’s phenomenon. This instalment looks at intravenous administration of iloprost in patients with severe Raynaud’s phenomenon. In the UK, the iloprost nebulizer solution is licensed as Ventavis (electronic Medicines Compendium, 2014). Iloprost injection is available as an unlicensed product in the UK but is licensed (Ilomedin) in other parts of the world (Bayer New Zealand Limited, 2012). Raynaud’s phenomenon is characterized by paroxysmal vasospasm followed by vasodilation of the peripheral arterioles, most commonly of the hands and feet (Tidy, 2013). The term ‘Raynaud’s phenomenon’ encompasses both Raynaud’s disease and Raynaud’s syndrome, although there is some overlap between them: ■ Primary Raynaud’s phenomenon (Raynaud’s disease) has no known cause. It occurs mostly in younger people (usually under the age of 30 years, although it can occur at any age) and is more common in women. It often has a genetic component— about a third of patients have a firstdegree relative affected ■ Secondary Raynaud’s phenomenon (Raynaud’s syndrome) is less common but has a known cause. It occurs mostly in people over the age of 30 years, but can occur at any age. It is linked to multiple causes including autoimmune disease; arterial and vasospastic disorders; haematological, endocrine and metabolic disorders; mechanical and environmental factors, such as vibration and smoking; malignant disease; infection; and some drugs, including betablockers and certain cytotoxics. Intravenous iloprost infusion can be used to treat primary and secondary Raynaud’s phenomenon. It reduces the frequency and severity of attacks and Alison Eggleton