title: [Combined treatment with intravenous prostacyclin and sildenafil in patients with pulmonary hypertension: report of 4 cases].
abstract: OBJECTIVE
  Here we report the experience obtained from a combined treatment with intravenous (i.v) prostacyclin and oral sildenafil in patients with severe pulmonary hypertension (PHT) who had a poor response to prior treatment with prostacyclin alone.
  
  
  METHODS
  Sildenafil was added to the treatment in four patients with PHT (primary in two patients and secondary to collagenosis in the other two) with no adequate response to i.v. prostacyclin treatment. The clinical course, 6minutes walking test and echocardiogram were evaluated.
  
  
  RESULTS
  Initial sildenafil dose was 12.5 mg three times daily, which was increased up to 50 mg three times daily in one patient and up to 50 mg four times daily in the other three. The symptoms of right heart failure were controlled in all cases. Before the start of sildenafil administration, two patients had class III dyspnea and two patients had class IV dyspnea. Two patients converted to class I (previously class III and IV), and the other two converted to class II. The distance walked within 6 minutes increased (average increase 55%) and systolic pulmonary artery pressure decreased in all patients (average reduction 27%). Effects of sildenafil were substained. The only side effect seen was mild headache.
  
  
  CONCLUSIONS
  Our experience supports the value of sildenafil in the treatment of PHT and suggests that combined treatment is useful for rescuing patients who fail to respond to initial treatment with i.v. prostacyclin.
authors.affiliation: Unidad de Colagenosis. Hospital Universitario Virgen del Rocío. Sevilla. Spain.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: García Hernández
authors.forename: Celia
authors.initials: C
authors.lastname: Ocaña Medina
authors.forename: Luis
authors.initials: L
authors.lastname: Mateos Romero
authors.forename: Angel
authors.initials: A
authors.lastname: Martínez Martínez
authors.forename: Andrés
authors.initials: A
authors.lastname: Bautista Lorite
authors.forename: Bernardo
authors.initials: B
authors.lastname: Santos Ramos
authors.forename: Julio
authors.initials: J
authors.lastname: Sánchez Román
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D011464:Epoprostenol