prostacyclinanalogen

Prostacyclin analogs are drugs that mimic the effects of prostacyclin (PGI2), a vasodilator produced by endothelial cells. They are used to produce smooth muscle relaxation and to inhibit platelet aggregation, with additional anti-proliferative effects on vascular walls. Clinically, they are most important in the management of pulmonary arterial hypertension (PAH) and may also be used for certain vascular and digital ulcer complications in systemic sclerosis.

Most prostacyclin analogs act through the IP receptor, increasing cyclic adenosine monophosphate (cAMP) in target cells to promote vasodilation and inhibit platelet aggregation. They differ in pharmacokinetics and routes of administration. Epoprostenol is given by continuous IV infusion due to a very short half-life. Iloprost is commonly inhaled several times daily. Treprostinil is versatile, available as IV, subcutaneous, inhaled, or oral forms. Beraprost is an oral agent with a longer duration of action. Selexipag is a non-prostanoid IP receptor agonist often discussed with prostacyclin pathway therapies but is not a prostacyclin analog.

Indications center on PAH (especially WHO class II–IV) to improve hemodynamics and exercise capacity, and some agents are used for systemic sclerosis–related digital ulcers or other vascular symptoms. They are typically considered when other PAH therapies are insufficient, and may be used in combination with endothelin receptor antagonists or PDE-5 inhibitors.

Common adverse effects include headache, flushing, jaw and throat pain, nausea, hypotension, and infusion-site reactions; inhaled forms may cause cough. Long-term IV therapy carries infection and catheter-related risks.