title: Sildenafil and bosentan plasma concentrations in a human immunodeficiency virus- infected patient with pulmonary arterial hypertension treated with ritonavir-boosted protease inhibitor.
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.
authors: Second Infectious Diseases Unit, L. Spallanzani National Institute for Infectious Diseases , Rome.
authors: Pierangelo
authors: P
authors: Chinello
authors: Second Infectious Diseases Unit, L. Spallanzani National Institute for Infectious Diseases , Rome.
authors: Stefania
authors: S
authors: Cicalini
authors: Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation, National Institute of Health , Rome.
authors: Simona
authors: S
authors: Pichini
authors: Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation, National Institute of Health , Rome.
authors: Roberta
authors: R
authors: Pacifici
authors: Clinical Biochemistry and Pharmacology Laboratory, L. Spallanzani National Institute for Infectious Diseases , Rome.
authors: Massimo
authors: M
authors: Tempestilli
authors: III Cardiology Unit, S. Camillo-Forlanini Hospital , Rome, Italy.
authors: Maria P
authors: MP
authors: Cicini
authors: Clinical Biochemistry and Pharmacology Laboratory, L. Spallanzani National Institute for Infectious Diseases , Rome.
authors: Leopoldo P
authors: LP
authors: Pucillo
authors: Second Infectious Diseases Unit, L. Spallanzani National Institute for Infectious Diseases , Rome.
authors: Nicola
authors: N
authors: Petrosillo
keywords: bosentan; human immunodeficiency virus; protease inhibitors; pulmonary arterial hypertension; sildenafil