Consecutive use of sildenafil and bosentan for the treatment of pulmonary arterial hypertension associated with collagen vascular disease: sildenafil as reliever and bosentan as controller

Abstract

Sildenafil and bosentan were added recently to the treatment with great expectations, effectiveness for the acute exacerbation of pulmonary arterial hypertension (PAH) is not fully examined. Two cases of acutely exacerbated PAH associated with collagen vascular diseases were treated first with sildenafil for six months followed by bosentan for another six months and the characteristics of this treatment modality were examined. Sildenafil showed an immediate effect which started in as early as ~30 min and was maximized in 60—90 min after oral ingestion. Continuous use of sildenafil for six months lowered pulmonary arterial pressure, pulmonary vascular resistance and the levels of brain natriuretic peptides along with an increased distance in 6-minute-walk, and replacement of it to with bosentan kept these effects. We think it as a treatment choice to use sildenafil first as a reliever and replace it with a controller bosentan, considering the immediate effects of sildenafil. Lupus (2007) 16 , 901—903.

Keywords

bosentan brain natriuretic peptides collagen vascular diseases pulmonary arterial hypertension sildenafil

Get full access to this article

View all access options for this article.

References

Olivari MT , Levine TB , Weir EK , Cohn JN Hemodynamic effects of nifedipine at rest and during exercise in primary pulmonary hypertension. Chest 1984; 86: 14—19.

Szczeklik J. , Dubiel JS , Mysik M. , Pyzik Z. , Krol R. , Horzela T. Effects of prostaglandin E1 on pulmonary circulation in patients with pulmonary hypertension. Br Heart J 1978; 40: 1397—1401.

Michelakis E. , Tymchak W. , Lien D. , Webster L. , Hashimoto K. , Archer S. Oral sildenafil is an effective and specific pulmonary vasodilator in patients with pulmonary arterial hypertension: comparison with inhaled nitric oxide. Circulation 2002 ; 105: 2398—2403.

Rubin LJ , Badesch DB , Barst RJ et al. Bosentan therapy for pulmonary arterial hypertension. N Engl J Med 2002; 346: 896—903.

Sutsch G. , Kiowski W. , Yan XW et al. Short-term oral endothelin-receptor antagonist therapy in conventionally treated patients with symptomatic severe chronic heart failure. Circulation 1998; 98: 2262—2268.

Park SH , Saleh D. , Giaid A. , Michel RP Increased endothelin-1 in bleomycin-induced pulmonary fibrosis and the effect of an endothelin receptor antagonist. Am J Respir Crit Care Med 1997; 156: 600—608.

Paul GA , Gibbs JS , Boobis AR , Abbas A. , Wilkins MR Bosentan decreases the plasma concentration of sildenafil when coprescribed in pulmonary hypertension. Br J Clin Pharmacol, 2005; 60: 107—112.