Prostaglandins

What are prostaglandins?

Prostagladins are a type of targeted therapy used to treat people with pulmonary hypertension (PH). Targeted therapies slow the progression of PH and may even reverse some of the damage to the heart and lungs.

There are three types of prostaglandin currently used to treat PH:

  • epoprostenol (Flolan)
  • iloprost (Ventavis)
  • treprostinil (Remodulin).

How do prostaglandins work?

Prostaglandin is a substance produced in the body that causes the blood vessels The blood vessel delivering blood to the lungs from the right side of the heart. in the lungs to dilate (become wider). Epoprostenol, iloprost and treprostinil are man-made prostaglandins. They work in a number of ways to improve PH:

  • Dilate the blood vessels in lungs, improving the amount of blood being pumped around the body at a given time and the amount of oxygen in the blood
  • Slow scarring and cell growth in the blood vessels of the lungs.

How are prostaglandins taken?

Patients need a great deal of specialist support, management and training to use prostaglandins safely and effectively.

Each prostaglandin has a different method of administration. If you are being treated with a prostaglandin you will need a stay in hospital to learn how to take your treatment.

Your PH specialist team will ensure you have all the information and training you need.

Epoprostenol

Epoprostenol is given intravenously (injected directly into a vein) via a permanent catheter (a thin, flexible tube that is inserted into a vein). This catheter is called a Hickman line or a Groshong line.

Hickman line

A Hickman line inserted into a large vein going to the heart

Epoprostenol is continuously pumped into the body by a portable, battery-operated pump. It must be given this way because it only lasts for 3–5 minutes in the bloodstream. The pump attaches to the Hickman line via a thin plastic tube. The pump is worn attached to a belt around the waist or carried in a small shoulder pack. Smaller children usually use a secure backpack.

Iloprost

Iloprost is usually inhaled into the lungs using a nebuliser.A device used to administer medication into the airways in a liquid mist form. It is very commonly used in lung diseases. Iloprost has to be taken about six or seven times a day. This is because it lasts about 1 or 2 hours in the bloodstream.

Iloprost can also be given intravenously, like epoprostenol.

Iloprost nebuliser

An iloprost nebuliser

Treprostinil

Treprostinil is given subcutaneously (under the skin). A catheter is inserted under the skin. The catheter stays in the same infusion site (place where the catheter is inserted under the skin) for up to 3 days. Like epoprostenol, treprostinil is delivered into the body by a portable pump. There are various pumps available currently, and these continue to change as technologies improve. Treprostinil can also be given intravenously (injected directly into a vein).

A typical infusion pump and catheter for treprostinil

A typical infusion pump and catheter

Risks associated with taking prostaglandins

All prostaglandins are associated with different risks.

In people using intravenous prostaglandins, Hickman line infections occur occasionally and are a serious concern. You will have to go to hospital if your Hickman line gets infected and you will need antibiotics. You may even have to have the Hickman line replaced.

Treprostinil can cause pain at the site of administration (where the catheter enters the body). This pain can be quite severe for some patients. You will be given painkillers if you need them. If the pain becomes too much you may have to change to a different treatment.

All prostaglandins also cause similar side effects. These may include:

  • headache
  • flushing
  • jaw pain
  • nausea
  • vomiting.

 

Last updated: April 4th, 2012. Review date April 3rd 2015
A full list of references used can be obtained by contacting the PHA UK Office

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