Iloprost
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Diarrhoea, rebound tachycardia and worsening of symptoms: 3 case reports In a case report three male patients [ages not stated] were described, who received treatment with iloprost for coronavirus disease-2019 (COVID-19) related vasculopathy. Out of whom 2 patients experienced worsening of symptoms and rebound tachycardia, and remaining one developed diarrhoea along with worsening of symptoms and rebound tachycardia. The patients were hospitalised with severe COVID-19. Two of them was presented with clinical evidence of digital ischaemia. The patients were obese. They started therapy with oxygen via a venturi mask and fluids, prophylactic anticoagulation and IV amoxicillin/ clavulanic acid [coamoxiclav]. Two of them received oral clarithromycin. However, the organ Failure assessment score was 6 and the ratio of arterial oxygen partial pressure to fractional inspired oxygen was 155. Hence, IV infusion of iloprost was recommended for 5 days based on the diagnosis of digital ischaemia, and a persistent oxygen requirement that probably reflected systemic microvasculopathy. A sustained clinical improvement in the digital ischaemia was observed after continuous administration of iloprost infusion of 0 5 mg/kg/min for 5 days, and a cardiovascular and respiratory parameters improvement also observed. The oxygen requirements decreased for all of them. An increasing arterial oxygen partial pressure to fractional inspired oxygen ratio and normalisation of heart rate were found up to 48h after the cessation of the iloprost infusion. Although, one patient experienced diarrhoea during the infusion and iloprost withdrawal and the day of cessation he experienced a mild rebound tachycardia and transient worsening of symptoms. Another two patients also experienced a mild rebound tachycardia and transient worsening of symptoms, but the issue resolved without any further treatment. Therefore, the patients were discharged from the hospital [time to reactions onset not stated; not all outcomes stated]. Moezinia CJ, et al. Iloprost for COVID-19-related vasculopathy. The Lancet Rheumatology 2: e582-e583, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1016/ 803507516 S2665-9913%2820%2930232-0
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Reactions 17 Oct 2020 No. 1826
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