title: Sildenafil plasma concentrations in two HIV patients with pulmonary hypertension treated with ritonavir-boosted protease inhibitors.
abstract: Sildenafil is increasingly used for the therapy of pulmonary arterial hypertension (PAH) in HIV infected patients. However, concerns exist about pharmacokinetic interactions between sildenafil and protease inhibitors (PI); in particular, ritonavir has been shown to increase sildenafil AUC and Cmax by several folds. The aim of our study was to determine the plasma levels of sildenafil and PI in two HIV patients with PAH treated with antiretroviral therapy including ritonavir-boosted PI. Our patients both experienced sildenafil Cmax above 500 ng/mL; however, they did not report any significant adverse reactions to sildenafil during the follow-up period. Therapeutic drug monitoring of sildenafil should be taken in consideration during treatment in order to avoid overdosage.
authors.affiliation: 2nd Infectious Diseases Unit, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy. pierangelo.chinello@inmi.it
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Chinello
authors.forename: Stefania
authors.initials: S
authors.lastname: Cicalini
authors.forename: Simona
authors.initials: S
authors.lastname: Pichini
authors.forename: Roberta
authors.initials: R
authors.lastname: Pacifici
authors.forename: Massimo
authors.initials: M
authors.lastname: Tempestilli
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
mesh_terms: D000328:Adult; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D011687:Purines / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D019438:Ritonavir / Q000627:therapeutic use*; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D017320:HIV Protease Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D019438:Ritonavir