Iloprost Infusion Research Articles

Central venous catheter-related blood stream infections in patients receiving intravenous iloprost for pulmonary hypertension

Catheter-related blood stream infection (CR-BSI) in patients with pulmonary hypertension (PH) receiving intravenous iloprost via an indwelling central line has previously not been fully described. Recent studies have suggested a link between the pH of prostanoid infusions and the rate and nature of CR-BSI. We have investigated CR-BSI in patients receiving intravenous iloprost at our unit. Databases and hospital records were interrogated for all patients receiving intravenous iloprost between September 2007 and June 2012. Fifty-nine patients received intravenous iloprost via an indwelling central catheter with a total of 23,072 treatment days. There were 15 episodes of CR-BSI, identified using a systematic screening protocol, involving 11 patients giving an overall CR-BSI rate of 0.65/1,000 treatment days. CR-BSI rate for Gram-positive organisms was 0.26/1,000 treatment-days and for Gram-negative organisms was 0.39/1,000 treatment-days. The pH of iloprost in typical dosing regimens was comparable to the pH used in standard-diluent treprostinil and dissimilar to alkaline epoprostenol infusions. The proportion of Gram-negative CR-BSI was similar to that reported for standard-diluent treprostinil. CRP was normal on admission in 33% of cases of confirmed CR-BSI and remained normal in 13% of cases. CR-BSI rates with intravenous iloprost are comparable to those observed for other prostanoids. The high proportion of Gram-negative organisms observed and the neutral pH of iloprost infusions support the previously hypothesised link between pH and antimicrobial activity. Although usually elevated during a CR-BSI, CRP may be normal in early infection and a normal result cannot completely exclude infection.

An experimental model of aortic surgery and the effect of Iloprost on lung injury

Objectives. Ischemia/reperfusion (I/R) damage of the lung is a frequently encountered complication following aortic surgery. The aim of the present study is to investigate the histopathological effects of Iloprost on pulmonary damage developed after I/R. Design. Twenty-four Sprague-Dawley rats were randomly divided into 3 groups. In the control group, aortas were not clamped. In the I/R group, aortas were occluded, and after 1 h of ischemia, clamps were removed. After 2 h of reperfusion period, lungs of the rats were extracted. In the I/R + Iloprost group after 1 h of ischemia, Iloprost infusion was initiated, and maintained for the duration of 2 h reperfusion period. For histopathological scoring, density of polymorphonuclear leucocytes, congestion, interstitial edema, and bleeding were semiquantitatively evaluated, and histopathological changes were scored. Results. In the I/R group, multifocal-marked histopathological changes in 5 (62.5%), and multifocal-moderate histopathological changes in 3 (37.5%) rats were detected. In the I/R + Iloprost group, multifocal-moderate histopathological changes in 4 (50%), and multifocal-mild changes in 4 (50%) rats were detected. Conclusions. In the experimental rat model, administration of Iloprost has been shown to have preventive effects for pulmonary damage occurring after I/R generated by infrarenal aortic occlusion.

Bleomycin-Induced Raynaud's Phenomenon After Single-Dose Exposure: Risk Factors and Treatment With Intravenous Iloprost Infusion

Bleomycin-Induced Raynaud's Phenomenon After Single-Dose Exposure: Risk Factors and Treatment With Intravenous Iloprost Infusion

Iloprost infusion by a new device as a portable syringe pump: safety, tolerability and agreement

Background Iloprost, prostacyclin (PGI2) analogue, effective in treatment of peripheral arterial disease, secondary Raynaud's phenomenon (RP) to connective tissue disease (CTD), vasculitis, pulmonary hypertension, is usually infused through peristaltic pump, or recently through a flow regulator.Materials and methods We tested a new portable syringe pump (Pompa Infonde®, Italfarmaco S.p.A., Cinisello Balsamo, Milano) on 120 patients affected by RP to CTD and cryoglobulinaemia, in iloprost therapy with a flow regulator.Results Iloprost infused through portable syringe pump is better tolerated, better appreciated by the patients and nurses and no difference was observed on therapeutic effects, with a lower incidence of side effects statistically significant. Only 3 patients were unable to tolerate the device (2 for changes in pressure and 1 for fear) and shifted to traditional method of iloprost infusion.Conclusions Iloprost infusion through the portable syringe Pompa Infonde® appears to be safe, better tolerated, more acceptable and equally effective compared to infusion through a flow regulator.

Longterm Effects of Endothelin Receptor Antagonism on Microvascular Damage Evaluated by Nailfold Capillaroscopic Analysis in Systemic Sclerosis

Systemic sclerosis (SSc) is characterized by microvascular injury, fibrosis, and hypoxia of involved tissues. The vasoactive peptide endothelin-1 (ET-1) seems to be implicated in these events. Using nailfold videocapillaroscopy (NVC), we evaluated longterm effects of ET-1 antagonist treatment on nailfold microvascular damage in patients with SSc, over a 3-year followup period. Thirty patients with SSc (mean age 64 ± 5 yrs, mean disease duration 8 ± 1 yrs) were recruited during their programmed standard treatment protocols. At baseline (T0), 15 patients with SSc (mean age 63 ± 15 yrs, mean disease duration 7 ± 3 yrs), already receiving cyclic intravenous infusion of iloprost (5 continuous days, average 80 μg/day, every 3 mo), continued the treatment for a further 3 years (ILO group). The remaining 15 patients with SSc (mean age 68 ± 13 yrs, mean disease duration 8 ± 4 yrs), although they continued the same cyclic intravenous iloprost treatment as the previous group, also received bosentan 125 mg twice a day for 3 years (ILO+BOS group). Qualitative analysis (scleroderma patterns) and semiquantitative scoring of the microvascular damage were performed by validated routine NVC methods. During followup, a statistically significant increase of capillary number was observed in the ILO+BOS group (p < 0.02), with a significant and progressive increase of angiogenesis (p < 0.01). In contrast, the ILO group showed a statistically significant decrease of capillary number (p < 0.05). After 3 years the number of capillaries was significantly higher in the ILO+BOS group than in the ILO group (p < 0.05). The score for giant capillaries decreased significantly in both groups of patients with SSc (p < 0.05). In this open study, longterm treatment with ET-1 receptor antagonist in combination with iloprost was found to interfere with progression of nailfold microvascular damage in patients with SSc, as assessed by NVC over a 3-year followup period.

Un nuovo device per la somministrazione di iloprost mediante pompa a siringa portatile: sicurezza, tollerabilità e gradimento

Summary Background Iloprost, prostacyclin (PGI2) analogue, effective in treatment of peripheral arterial disease, secondary Raynaud's phenomenon (RP) to connective tissue disease (CTD), vasculitis, pulmonary hypertension, is usually infused through peristaltic pump, or recently through a flow regulator. Materials and methods We tested a new portable syringe pump (Pompa Infonde®, Italfarmaco S.p.A., Cinisello Balsamo, Milano) on 120 patients affected by RP to CTD and cryoglobulinaemia, in iloprost therapy with a flow regulator. Results Iloprost infused through portable syringe pump is better tolerated, better appreciated by the patients and nurses and no difference was observed on therapeutic effects, with a lower incidence of side effects statistically significant. Only 3 patients were unable to tolerate the device (2 for changes in pressure and 1 for fear) and shifted to traditional method of iloprost infusion. Conclusions Iloprost infusion through the portable syringe Pompa Infonde® appears to be safe, better tolerated, more acceptable and equally effective compared to infusion through a flow regulator.

Paradoxical Reaction of Raynaud Phenomenon following the Repeated Administration of Lloprost in a Patient with Diffuse Cutaneous Systemic Sclerosis

To report a paradoxical reaction of Raynaud phenomenon following the repeated administration of iloprost in a patient with diffuse cutaneous systemic sclerosis with vascular involvement. In January 2006, a 40-year-old male was diagnosed with diffuse cutaneous systemic sclerosis with pulmonary, esophageal, cutaneous, and vascular involvement (Raynaud phenomenon, with digital ulcers on his hands). In December 2008, treatment with iloprost was started due to worsening disease. Nine cycles of iloprost were administered at a rate of 0.5-1 ng/kg/min (6 hours per day, for 5 days every 6-8 weeks); the patient tolerated this treatment well. However, on the fourth day of cycles 10 and 11, the patient developed paradoxical Raynaud phenomenon in the hand with perfusion when the infusion was increased to 1 ng/kg/min, requiring treatment to be stopped. Treatment was continued during cycles 12 and 13 at 0.5 ng/kg/min; the patient tolerated the treatment well, although paradoxical Raynaud phenomenon occurred when the rate of infusion was increased. Raynaud phenomenon is extremely common in patients with scleroderma, and often is severe. Iloprost has vasodilating, antiplatelet, cytoprotective, and immunomodulating properties, and has been found to be an efficacious alternative to nifedipine for the treatment of Raynaud phenomenon in patients with scleroderma. The Naranjo probability scale indicated that iloprost was the probable cause of the paradoxical Raynaud phenomenon in this patient. This case demonstrates a probable relationship between the rate of infusion of iloprost and the paradoxical reaction of Raynaud phenomenon.

A single center, open, randomized study investigating the clinical safety and the endothelial modulating effects of a prostacyclin analog in combination with eptifibatide in patients having undergone primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction

Treatment with the endothelial modulator prostacyclin may be beneficial in patients with endothelial dysfunction. The primary aim of the present pilot study was to evaluate the safety and the potential endothelial modulating affect of the prostacyclin analog iloprost in patients with a recent ST segment elevation myocardial infarction (STEMI). Seventeen patients were randomized to either 24h of iloprost infusion in combination with low dose eptifibatide infusion or saline infusion+eptifibatide. The study was randomized and open labeled.None of the patients experienced any bleeding complications and vital signs were stable throughout the entire study period in both groups. None of the functional hemostatic whole blood assays applied in the present study differed between the active treatment and the placebo group. The endothelial marker, sE-selectin, displayed a decrease over time in the iloprost group but increased in the placebo group (p=0.008), whereas none of the other biomarkers of endothelial cell and glycocalyx activation or damage differed significantly between the groups.In this pilot study, infusion of a prostacyclin analog appeared safe and has a detectable modulating effect of activated endothelium in patients with a recent STEMI.ClinicalTrials.gov: NCT01179776.

Protective effects of hyperbaric oxygen and iloprost on ischemia/reperfusion-induced lung injury in a rabbit model

BackgroundThe role of multiorgan damage in the mortality caused by ischemic limb injury is still not clarified. The objective of this study was to examine the potential protective effects of hyperbaric oxygen (HBO) and iloprost (IL) therapy on lung damage induced by limb ischemia/reperfusion injury in a rabbit model, using both biochemical and histopathological aspects.MethodsForty New Zealand white rabbits were randomly allocated into one of five study groups: HBO group (single session of HBO treatment); IL group (25 ng/kg/min infusion of IL); HBO + IL group (both HBO and IL); Control group (0.9% saline only); and a sham group. Acute hind limb ischemia-reperfusion was established by clamping the abdominal aorta for 1 h. HBO treatment and IL infusion were administrated during 60 min of ischemia and 60 min of reperfusion period. Blood pH, partial pressure of oxygen, partial pressure of carbon dioxide and levels of bicarbonate, sodium, potassium, creatine kinase, lactate dehydrogenase, and tumor necrosis factor alpha were determined at the end of the reperfusion period. Malondialdehyde was measured in the plasma and lung as an indicator of free radicals. After sacrifice, left lungs were removed and histopathological examination determined the degree of lung injury.ResultsIn the control group, blood partial pressure of oxygen and bicarbonate levels were significantly lower and creatine kinase, lactate dehydrogenase, malondialdehyde and tumor necrosis factor-α levels were significantly higher than those of the HBO group, IL group, HBO + IL group and sham group. Similarly, the malondialdehyde levels in the lung tissue and plasma levels were significantly lower in the treatment groups compared with the control group. The extent of lung injury according to the histological findings was significantly higher in the control group.ConclusionsThese results suggest that both HBO and IL therapies and their combination might be effectively used in the prevention of lung injury after ischemia/reperfusion injury of the lower extremities.

Abstract 16790: Positive Inotropic Effects of Acute Intravenous Iloprost in Rats with Chronic Pulmonary Arterial Hypertension

Introduction: Pulmonary arterial hypertension (PAH) is a syndrome of increased pulmonary vascular resistance that ultimately leads to right ventricular failure. Supportive management for decompensated RV function in chronic PAH is not very well understood and acute administration of prostacyclins is sometimes considered. While prior studies of inotropic effects of prostacyclins on models of acute pulmonary hypertension have yielded mixed results, evaluation of these effects under conditions of chronic PAH and RV dysfunction have not been reported using invasive hemodynamics. We sought to study the effects of an acute intravenous infusion of iloprost on right ventricular contractility in a rat model of chronic PAH. Methods: Ten Sprague-Dawley rats weighing 250-350g were treated with monocrotaline 60mg/kg IP. Six weeks later, baseline hemodynamic assessment was done using pressure-volume measurements using conductance catheterization, and these were repeated 10-15 minutes after IV infusion of iloprost (20 µg/kg ). RV contractility was assessed by the End-systolic pressure volume relationship (ESPVR), and Ees/Ea (RV/PA coupling) were obtained by transient decrease in preload (IVC occlusion). All values are reported as mean ± SEM. Paired and unpaired analysis was performed using Student's t-test. Results: Animals had evidence of PAH and RV hypertrophy. RV/LV+septum weight was 0.40 (±0.03). Right ventricular systolic pressure (RVSP) was 39.83 (±1.62) mmHg. Administration of iloprost demonstrated a significant increase in the slope of the ESPVR from 0.29 (±0.02) to 0.42 (±0.05) (p&lt;0.05), and ventricular-arterial coupling index Ees/Ea increased from 0.63 (±0.07) to 0.82 (±0.06) (p&lt;0.05). RV contractility index (max dP/dt normalized for instantaneous pressure) increased from 94.11/s to 114.5/s (p&lt;0.05) as did RV ejection fraction from 48.0% to 52.5% (p&lt;0.05). Pulmonary vascular resistance decreased from 0. 50 (±0.05) to 0.33 (±0.05) Wood units (p&lt;0.05). Conclusion: Our present study suggests a positive inotropic effect of iloprost (as evidenced by RV contractility index and ESPVR on remodeled right ventricles resulting from chronic PAH. The role of prostacyclins in the acute treatment algorithm of PAH merits further study.

Long-term effects of cyclic therapy with iloprost in systemic sclerosis

To assess the long-term effects of cyclic infusion of iloprost, a derivative of prostacyclin, on Raynaud's phenomenon-related symptoms and ischemic ulcers in patients with Systemic Sclerosis (SSc). A retrospective analysis of prospectively collected parameters in 59 consecutive SSc patients, followed at one institution, who were treated for a median time of 52 months with iloprost for severe Raynaud's phenomenon and ischemic ulcers. Among the 50 patients with ischemic ulcers at the start of therapy, 35 (70%) did not show lesions at the last observation. Despite therapy, four patients underwent amputations (two of forefoot, two of finger distal phalanges). Compared to the pre-treatment point, we observed: decrease of the Raynaud's phenomenon VAS (p<0.001), and, in patients with diffuse cutaneous involvement, of the modified Rodnan skin thickness score (p=0.002). The Health Assessment Questionnaire was not significantly improved. Treatment with cyclic iloprost can control Raynaud's phenomenon-related symptoms and ischemic ulcers in the large majority of patients with SSc. However, a disease-modifying effect of this therapy could not be demonstrated.

Tolerability, safety and efficacy of Iloprost infusion without peristaltic pump in systemic sclerosis

OBJECTIVE: To evaluate safety, tolerability and efficacy on Raynaud's phenomenon (Rp) of iloprost infusion without peristaltic pump in patients with systemic sclerosis (SSc). PATIENTS AND METHODS: The inclusion criteria were diagnosis of SSc, age between 18 and 65 years, presence of Rp, and absence of any contraindication to the use of iloprost. The treatment was carried out in a day hospital setting and consisted first of 5 consecutive days of iloprost infusion (from an initial dose of 1.0 ng/Kg/min up to 2 ng/kg/min), and then of 2 days of infusions at the maximum possible dose every 45 days for one year. All of the adverse events were carefully recorded and the changes in the Rp were measured by a 5 grade scale (worsened, unmodified, slightly improved, very improved, disappeared). RESULTS: Thirty-eight SSc patients (all females), mean age 49 years (range 18.5-65), disease duration 1.5 years (range 0.5-10.8) were enrolled in the study. During the first cycle of therapy, 14 adverse events occurred in 11 (28.9%) patients and during the next cycles, 3 adverse events were seen in 3 (7.9%) patients. In all of the cases they were mild and transient. Rp was considered very improved in 15 (39.5%) patients, slightly improved in 13 (34.2%), unmodified in 8 (21%) and worse in 2 (5.2%). DISCUSSION: In this study intravenous iloprost without peristaltic pump proved to be safe, well tolerated, and as effective as traditional infusion through peristaltic pump in improving Rp in patients with SSc.

Is Thromboangiitis Obliterans Presentation Influenced by Cannabis Addiction?

Cannabis implication in the pathophysiology of distal arteritis remains controversial. The aim is to assess whether cannabis co-exposure influences presentation and outcome of thromboangiitis obliterans (TAO) in tobacco smokers. All consecutive patients presenting with a definite TAO were retrospectively reviewed according to their tobacco and cannabis consumption status. A total of 38 patients with a definite TAO were included in this study. In all, 10 patients (26%) used tobacco together with cannabis (δ9-trans-tetrahydrocannabinol [THC], THC(+)), whereas 28 patients (74%) were only tobacco smokers (THC(-)). Tobacco exposure was comparable in both groups (21.7 ± 12 vs. 26.7 ± 17 pack-years). THC(+) patients were younger than THC(-) patients at onset of symptoms (28.5 ± 7 years vs. 36.6 ± 10.5 years, p = 0.02) and have more frequently unilateral involvement of lower limbs (44% vs. 7%, p = 0.02). Although 66% of patients presented with critical ischemia of lower limbs, THC(+) patients exhibited more often rest pain without ischemic ulcers (50% vs. 5%, p = 0.048). Upper limbs were clinically affected in 50% of THC(+) patients and 32% of THC(-) patients. Repeated infusions of iloprost were required in 84% of patients. Outcome and rate of minor and major amputations (10%) did not differ between groups. Cannabis exposure influences the age at onset and presentation of TAO, but not the outcome. The data of present study suggest that cannabis represent a co-factor of tobacco that may accelerate TAO onset and presentation.

Compartment Syndrome as a Rare Complication of Iloprost Infusion for Peripheral Vascular Disease

We report a case of acute compartment syndrome associated with the use of iloprost in the treatment of Buerger's disease. After a four-compartmental fasciotomy of the affected lower limb, the patient made a complete recovery.

Long-term effects of intermittent Iloprost infusion on pulmonary arterial pressure in connective tissue disease

Background Intravenous periodic Iloprost is proven effective in the treatment of Raynaud phenomenon (RP) related to connective tissue disorder (CTD). It's well known that synthetic prostaglandins are effective drugs for the treatment of pulmonary arterial hypertension (PAH), and that PAH is frequently associated with CTD. Objective The aim of the study is to evaluate in the chronic effect of cyclic intravenous Iloprost on pulmonary arterial pressure. Methods We studied 17 consecutive patients with CTD (14 systemic sclerosis, 3 mixed CTD) and RP, at the entry and after at least 6 months of treatment of RP with cyclic Iloprost. On both occasions, in all patients we performed transthoracic Doppler echocardiography and we determined NT-proBNP plasma levels, NYHA functional class, 6 Minute-Walk Distance (6MWD). Results At follow-up (8.2 ± 1.9 months; range 6–12) mean values of pulmonary arterial systolic pressure (PASP) significantly decreased (from 32.2 ± 9.2 to 29.2 ± 7.6 mmHg, p < 0.04) and mean values of 6MWD significantly increased (from 407.5 ± 101.5 to 448.3 ± 89.9 m, p < 0.01). Moreover, we observed a significant direct correlation between PASP and NT-proBNP values and a significant inverse correlation both between NT-proBNP and 6MWD values and between PASP and 6MWD values. Conclusion Our results suggest that cyclic intravenous Iloprost may protect against the development or worsening of PAH in patients with CTD and RP.

Inflammation, oxidative stress and platelet activation in aspirin-treated critical limb ischaemia: Beneficial effects of iloprost

Platelets critically contribute to atherothrombosis and worsening ischaemia in patients with peripheral arterial disease (PAD), eventually leading to critical limb ischaemia (CLI). Furthermore, persistent platelet activation despite antiplatelet therapy has been reported in this setting. The prostacyclin analogue iloprost is currently recommended in CLI patients for its effects in relieving symptoms by promoting local perfusion. In this study, we investigated the effects of iloprost infusion on urinary 11-dehydro-TXB₂ and 8-iso-PGF(₂α) excretion rate, as in vivo indexes of thromboxane-dependent platelet activation and lipid peroxidation, respectively, and on platelet-derived proinflammatory sCD40L and nitric oxide bioavailability in 44 patients with CLI while on chronic treatment with low-dose aspirin. Daily iloprost infusion for one-week significantly decreased urinary 11-dehydro-TXB₂ [499 (277-807) vs. 380 (189-560) pg/mg creatinine, p < 0.0001] and 8-iso-PGF(₂α) [533 (316-842) vs. 334 (196-540) pg/mg creatinine, p < 0.0001] as well as plasma sCD40L [1540 (1005-3015) vs. 948 (845-2030) pg/ml, p < 0.0001]. Furthermore, a significant increase in plasma nitrate plus nitrite levels has been observed [26.8 (18.8-35.9) vs. 43.7 (33.0-75.5) μM, p < 0.0001]. A significant direct correlation was also found between urinary 8-iso-PGF(₂α) and 11-dehydro-TXB2 before and after iloprost treatment (Rho = 0.695, p < 0.0001). In conclusion, we report that a short-term course of iloprost is able to significantly reduce residual thromboxane biosynthesis, oxidative stress, endothelial dysfunction and platelet-derived inflammation in low-dose aspirin treated patients with CLI.

Occurrence and Multiple Recurrence of Severe Vasospasm of the Upper Extremity Following Thorascopic Sympathectomy for Hyperhidrosis

Introduction Thorascopic sympathectomy is a widely used procedure for the treatment of intractable palmar hyperhidrosis. Report A 24-year-old woman who underwent thorascopic sympathectomy for hyperhidrosis in 2005 presented on more than 30 occasions with recurrent right distal upper limb ischaemia secondary to repetitive episodes of vasospasm. The patient did not have preoperative symptoms consistent with Raynaud’s syndrome. We observed a reduction in the symptomatic relief offered by Iloprost treatment over a period of five years. Discussion This is the first report of distal upper limb ischaemia following thorascopic sympathectomy. We highlight the development of resistance to repeated Iloprost infusions that we observed in this case.

Digitale Ulzerationen bei Sklerodermie – eine interdisziplinäre Herausforderung

Digital ulcers in systemic sclerosis are painful ischemic necrotic lesions of the acra. Optimal treatment consists of conventional wound management and medication: iloprost infusions promote primary healing of the ulcers, while the dual endothelin receptor antagonist bosentan is used for secondary prophylaxis of new ulcers. The described case illustrates the essential interdisciplinary collaboration for optimal management of these patients.

Bone marrow edema syndrome of the third metatarsal bone: a rare cause of metatarsalgia treated with Iloprost

Bone marrow edema syndrome (BMES) is a non-traumatic clinical condition characterized by typical pattern of changes on magnetic resonance imaging (MRI). The disease rarely occurs in the forefoot region. A 37-year-old woman was diagnosed with BMES of the third metatarsal bone with typical MRI findings. She was successfully treated with iloprost infusion therapy consisted of infusion of 40 μg of iloprost in 500 ml of sodium chloride solution given over 6 h daily, for five consecutive days. In conclusion, BMES should be kept in mind, as one of the causes of severe pain of forefoot region, and iloprost seems to be an effective treatment method for BMES.

Sicurezza e tollerabilità della somministrazione di iloprost senza pompa peristaltica

Iloprost is a potent prostacyclin (PGI2) analogue that is effective in the treatment of peripheral arterial disease, vasculitis, pulmonary hypertension, and secondary Raynaud's phenomenon. Intravenous infusions are generally administered with the aid of a peristaltic pump to reduce the risk of adverse reactions caused by unintentional increases in the infusion rate. This increases the cost of care in terms of equipment and personnel and may limit the use of this drug. We retrospectively analyzed 18,432 iloprost infusions administered between 1999 and 2009 to 272 patients with systemic sclerosis (n = 253) and 19 with peripheral arterial disease (n = 19). All infusions were administered in the day hospital over 6 h with a normal IV set-up with a roller flow regulator. Flow rates were set to deliver iloprost at 1-2 ng/kg/min. Rates were verified by direct drop counts during the first 15-20 minutes of the infusion and at each subsequent check. There were no adverse events that were fatal, life-threatening, or associated with prolongation of hospitalization and very few events requiring intensive care or continuous monitoring. The latter included 4 cases of tachycardia/arrhythmia (extrasystoles in most cases), 3 cases of hypotension (systolic pressure < 80 mmHg), and 2 cases of hypertension (BP > 170/100 mmHg). All other adverse reactions were mild, reversible, and similar to those seen with iloprost infusion with peristaltic pump. Only one patient had to be switched to another prostanoid (due to intolerance). Iloprost infusion administered with a normal IV flow regulator appears to be as safe, well tolerated, and effective as traditional infusion with a peristaltic pump.