Effect of inhaled iloprost plus oral sildenafil in patients with primary pulmonary hypertension.

Medizinische Klinik und Poliklinik, Innere Medizin V, Innere Medizin III, Homburg/Saar, Germany. inhwil@med-rz.uni-saarland.de
The application of iloprost, a stable prostacyclin analogue, by inhalation has been shown to improve hemodynamic variables in patients with primary pulmonary hypertension. However, repetitive inhalations are required due to its short-term effects. One potential approach to prolong and increase the vasorelaxant effects of aerosolized iloprost might be to combine use with phosphodiesterase inhibitors.The short-term effects of 8.4 to 10.5 microgram of aerosolized iloprost, the phosphodiesterase type 5 inhibitor sildenafil, and the combination thereof were compared in 5 patients with primary pulmonary hypertension. Aerosolized iloprost resulted in a more pronounced decrease in mean pulmonary arterial pressure (PAP) than sildenafil alone (9.4+/-1.3 versus 6.4+/-1.1 mm Hg; P<0.05). The reduction in mean PAP after sildenafil was maximal after the first dose (25 mg). The combination of sildenafil plus iloprost lowered mean PAP significantly more than iloprost alone (13.8+/-1.4 versus 9.4+/-1.3 mm Hg; P<0.009). No significant changes in heart rate or systemic arterial pressure were observed during any treatment. The treatments were well tolerated, without major adverse effects.Sildenafil caused a long-lasting reduction in mean PAP and pulmonary vascular resistance, with a further additional improvement after iloprost inhalation. These data suggest that small doses of a phosphodiesterase type 5 inhibitor may be a useful adjunct to inhaled iloprost in the management of pulmonary hypertension.
Mesh Terms:
Administration, Inhalation, Administration, Oral, Blood Pressure, Cardiac Output, Cough, Drug Therapy, Combination, Female, Headache, Hemodynamics, Humans, Hypertension, Pulmonary, Iloprost, Male, Middle Aged, Nausea, Phosphodiesterase Inhibitors, Piperazines, Pulmonary Artery, Purines, Sulfones, Time Factors, Treatment Outcome, Vascular Resistance, Vasodilator Agents
Circulation Sep. 11, 2001; 104(11);1218-22 [PUBMED:11551870]
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