Aerosolised iloprost improves pulmonary haemodynamics in patients with primary pulmonary hypertension receiving continuous epoprostenol treatment

Background-Continuous intravenous treatment with epoprostenol significantly improves pulmonary haemodynamics and survival in patients with primary pul monary hypertension (PPH). Its beneficial effect, however, may be blunted d ue to adverse effects such as catheter sepsis and systemic hypotension. Rec ent investigations have shown that inhaled iloprost is effective in the tre atment of PPH. Based on their different pharmacokinetics, we hypothesised t hat the combination of intravenous epo,prostenol and inhaled iloprost would be more efficacious than epoprostenol alone during acute testing in patien ts with PPH. Methods-The effect of a single dose of inhaled iloprost (30 mug total over 15 minutes) on pulmonary haemodynamics was examined in eight patients with PPH (initial non-responders to nitric oxide) who had considerable adverse e ffects during treatment with epoprostenol. Results-The combination of inhaled iloprost and intravenous epoprostenol si gnificantly improved mean pulmonary artery pressure (MPAP), cardiac index ( CI), mixed venous oxygen saturation (Svo(2)), and systemic arterial oxygen pressure (Pao(2) ) compared with epoprostenol treatment alone. Mean systemi c arterial pressure (MSAP) and pulmonary capillary wedge pressure (PCWP) re mained unchanged. Conclusions-The pulmonary vasoreactivity shown by additional iloprost inhal ation during effective epoprostenol treatment suggests that an improvement of treatment for pulmonary hypertension may be possible by combining vasoac tive substances.