Sildenafil and bosentan plasma concentrations in a human immunodeficiency virus-infected patient with pulmonary arterial hypertension treated with ritonavir-boosted protease inhibitor

Pierangelo Chinello, Stefania Cicalini, Simona Pichini, Roberta Pacifici, Massimo Tempestilli, Maria P. Cicini, Leopoldo P. Pucillo, Nicola Petrosillo

Research output: Contribution to journalArticlepeer-review

Abstract

Sildenafil and bosentan are increasingly used for the treatment of pulmonary arterial hypertension (PAH) in HIV-infected patients. However, concerns exist about pharmacokinetic interactions among sildenafil, bosentan and antiretroviral drugs, including protease inhibitors (PI). We describe here the case of an HIV-infected patient with PAH, who was co-administered bosentan 125 mg twice daily and sildenafil 40 mg three times per day, together with a ritonavir-boosted PI-based antiretroviral therapy; plasma levels of bosentan, sildenafil, N-desmethylsildenafil, and PI were measured. The patient had a sildenafil Cthrough and Cmax of 276.94 ng/mL and 1733.19 ng/mL, respectively. The Cthrough and the Cmax of bosentan were 1546.53 ng/mL and 3365.99 ng/mL, respectively. The patient was able to tolerate as high sildenafil blood concentrations as 10 times those usually requested and did not report any significant adverse reaction to sildenafil during the follow-up period. Therapeutic drug monitoring should be considered during sildenafil therapy in patients concomitantly treated with ritonavir-boosted PI.

Original languageEnglish
Article number5822
JournalInfectious Disease Reports
Volume7
Issue number1
DOIs
Publication statusPublished - 2015

Keywords

  • Bosentan
  • Human immunodeficiency virus
  • Protease inhibitors
  • Pulmonary arterial hypertension
  • Sildenafil

ASJC Scopus subject areas

  • Infectious Diseases

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