Iloprost (Ventavis®) - PHA Online University

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medication. The I-neb ® AAD ® System turns Ventavis ® into an aerosol (mist) that you inhale into yourlungs.Iloprost is initiated at a dose of 2.5 micrograms (mcg) and increased to 5 mcg (the usual dose) if thepatient tolerates the lower dose. Iloprost is given 6 to 9 times per day depending upon the responseand activity level of each patient. Each inhalation takes approximately 6-10 minutes depending on thebreathing pattern of each patient.Your doctor may prescribe Ventavis ® 20 mcg/mL if you have long treatment times and are maintainedat the 5 mcg dose. The higher concentration of medicine lowers the amount of solution you need totake by 50%, which gives you shorter treatment time.Because iloprost is an inhaled medication, patients should be careful not to expose others while takinga treatment. Patients should follow the manufacturer’s instructions for cleaning the I-neb ® AAD ® nebulizer system after each dose administration.How is iloprost supplied? (Please see package insert for full details)Iloprost comes in 1 mL glass vials (ampules) that can be stored at room temperature. There are 2concentrations: 10 mcg/mL and 20 mcg/mL.Based on the concentration, the delivered dose varies as in the table below.Delivered DoseDelivered DoseNebulizer 10 mcg/mL 20 mcg/mLI-neb ® AAD ®2.5 mcg or 5.0 mcg from 1ampule5.0 mcg from 1 ampuleFor each inhalation session, the entire contents of each opened ampule should be transferred into theI-neb ® AAD ® System medication chamber immediately before use.For the 10 mcg/mL solution, one mL of the solution contains 0.01 mg iloprost, 0.81 mg ethanol, 0.121mg tromethamine, 9.0 mg sodium chloride, and approximately 0.51 mg hydrochloric acid (for pHadjustment to 8.1) in water.For the 20 mcg/mL solution, one mL of the solution contains 0.02 mg iloprost, 1.62 mg ethanol, 0.242mg tromethamine, 9.0 mg sodium chloride, and approximately 0.76 mg hydrochloric acid (for pHadjustment to 8.4) in water.How can a patient obtain iloprost?Iloprost must be prescribed by a physician and insurance approval must be obtained prior to startingtherapy. Once approved by insurance, iloprost is then sent directly to patients by either of twospecialty pharmacies: Accredo Health Group, Inc. and CVS Caremark.Will insurance pay for iloprost?The cost of iloprost for 6 doses daily is about $145,635 per year.It is expected that most insurance plans will pay for iloprost prescriptions; however, plans with a setco-payment may result in additional cost to the patient.Medicaid and most state-run insurance plans will pay for iloprost. Medicare will also cover iloprost inmost cases under the part D component of that program.801 Roeder Rd, Ste. 1000 • Silver Spring, MD 20910 • (301) 565-3004 • www.PHAssociation.org • www.PHAOnlineUniv.org
Actelion PAH Pathways ® (866-288-3546) offers a variety of options to cover either partial or full drugcosts for any patient with qualifying financial circumstances. Caring Voice Coalition (888-267-1440),an organization that provides grants to assist with drug cost for patients with chronic illnesses, mayalso provide coverage if the patient qualifies for such assistance.What are the frequent side effects of iloprost?The most common side effects include flushing (vasodilation), increased cough, headache, spasm ofjaw muscles that makes it difficult to open your mouth and may cause jaw discomfort (trismus),insomnia, nausea, low blood pressure, vomiting, increased alkaline phosphatase or GGT (liverenzymes measured in the blood), flu syndrome –like symptoms, back pain, tongue pain, fast orirregular heart rate or rhythm (palpitations), passing out (syncope), muscle cramps, coughing upblood (hemoptysis), and pneumonia.Hypotension leading to syncope has been observed; iloprost should therefore not be initiated inpatients with systolic blood pressure less than 85 mmHg.Pulmonary venous hypertension and pulmonary edema can occur in which case iloprost should bepromptly discontinued.Iloprost inhalation can induce narrowed breathing tubes (airways), called bronchospasm, manifest ascough, wheezing or shortness of breath.Iloprost solution can also irritate the eyes and skin. If iloprost comes in contact with the skin or eyes,rinse immediately with water.How are side effects of iloprost monitored?Vital signs should be monitored while initiating iloprost. Iloprost should generally be avoided if thesystemic systolic blood pressure is below 85 mmHg.If you experience any of the symptoms mentioned in the previous section, you should promptly notifyyour physician.What are considerations for use of iloprost in special populations?Iloprost has been shown to cause damage to the fetus (i.e. teratogenic) in rats. Iloprost has not beenevaluated in pregnant women or women who are breastfeeding. Iloprost should be used in pregnant ornursing mothers only if the potential benefit justifies the risk to the fetus or infant.Safety and efficacy in pediatric patients has not been established.Clinical studies did not include a sufficient number of patients over age 65 to determine either safetyor efficacy.Iloprost has not been evaluated in patients with impaired liver (hepatic) function; however,consideration should be given to increasing the dosing interval (e.g. 3 to 4 hours between doses) inpatients with moderate to severe hepatic impairment.Iloprost has not been evaluated in patients with impaired kidney (renal) function. Likewise, the effectof dialysis in unknown.Could a patient be allergic to iloprost?This is unlikely. An ampule of iloprost does not contain preservatives or sulfites. However, anymedication can cause side effects or sensitivities and patients should check with their doctor if theyexperience a problem.801 Roeder Rd, Ste. 1000 • Silver Spring, MD 20910 • (301) 565-3004 • www.PHAssociation.org • www.PHAOnlineUniv.org
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