PROSTACYCLIN

New Wonder Drug for Treatment of Primary Pulmonaty Hypertension (PPH) 

Prostacyclin (PGI2) also known as Epoprostenol, is a powerful strong vasodilator and an inhibitor of platelet aggregation.Prostacyclin is licensed as an anticoagulant for use during renal dialysis, but was granted approval for use for severe PPH by the Federal Drug Administration in 1996. Prostacyclin therapy was initially used as a bridge to lung transplantation although it has also emerged as an alternative to transplantation in some patients. It is now advocated as a treatment of severe PPH. Since first described in 1984, a number of studies have found evidence of significant morbidity and mortality benefits to patients with severe primary pulmonary hypertension from prostacyclin treatment. In addition, the improvements in life expectancy increase the chances of a patient receiving a heart and lung transplant. Prostacyclin may also be associated with better outcomes for heart-lung transplantations. Observations on prostacyclin can be generalized to newer analogues such as iloprost. Although doctors are not certain exactly how Prostacyclin works. It does have several measurable effects.

How Prostacylin Works ?

Prostacyclin dilates blood vessels to some extent and it reduces blood clotting by stopping platelets (in the blood) from sticking together. Researchers believe that an abnormally low ratio of prostacyclin in relation to endogenous thromboxane (a vasoconstrictor that serves the opposite function: it stimulates platelet aggregation) may be partially responsible for the development of primary pulmonary hypertension. Thus prostacyclin improves cardiac output- the blood vessels are cleared out and it may slow the growth of muscle cells that cause these blood vessels to constrict. A downside to prostacyclin treatment is that it expires quickly and must be infused continuously by an automated syringe pump and through a permanent catheter. Also, the delivery system is complex and requires patients to learn the techniques of sterile preparation, operation of the pump, and care of the intravenous catheter. In some cases this type of infusion may create serious complications (e.g., sepsis, thromboembolism, or syncope) related to the use of an implanted central vein catheter. While the original delivery system for prostacyclin was intravenoous, there are new prostacyclin therapy options which include injection, oral / inhaled spray mist of prostacyclin and oral tablets of prostacyclin.

Prostacyclin is also known as Flolan, Remodulin (UT-15 or Uniprost), Iloprost and Beraprost

             Flolan -a synthetic administered intravenously directly into the bloodstream through a surgically implanted catheter

             Remodulin (UT-15 / Uniprost) - prostacyclin injected subcutaneously (under the skin) with a needle

             Iloprost - inhaled form of Prostacyclin

             Beraprost - the oral form of Prostacyclin made by United Therapeutics

Other New PPH Drugs Include:

            Bosentan (Tracleer) - orally active endothelin receptor antagonist by Actelion