Key result
Bosentan improves dyspnea and exercise tolerance in patients with WHO Class III and IV pulmonary arterial hypertension, but requires close monitoring for liver dysfunction and drug interactions.
Bosentan is an FDA-approved endothelin receptor antagonist for WHO Class III and IV PAH that improves dyspnea and exercise tolerance but requires strict monitoring for liver toxicity and teratogenicity.
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Supports bosentan for advanced PAH symptom relief with monitoring; leaves open comparative long-term data versus newer agents.
Bosentan is the first endothelin (ET) receptor antagonist approved by the Food and Drug Administration for the management of pulmonary arterial hypertension (PAH). In patients with World Health Organization Class III and IV PAH, bosentan has demonstrated improvement in dyspnea and exercise tolerance. ET also plays an important role in the pathophysiology of different vascular diseases. Therefore, bosentan also may have the potential to alter the outcome of many other diseases, such as heart failure, hypertension, ischemic heart disease, and renal disease, as well as cerebrovascular disorders. Because of the rarity and the poor prognosis of patients with PAH, as well as the requirement of close monitoring of bosentan (due to its potential of causing liver dysfunction and its teratogenic effects), bosentan is currently available only through a special access program and is distributed by certain selected pharmacies. Patients who are receiving bosentan should be taught to recognize early signs and symptoms of liver dysfunction and possible pregnancy. In addition, bosentan is not only a substrate but also an inducer of CYP3A4 and CYP2C9. Therefore, it is anticipated that numerous drug interactions may occur. Patients should be advised to consult their physicians or pharmacists should they need to consume other prescription or nonprescription medications.
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Judy Cheng (2003) conducted a review in Pulmonary arterial hypertension. Bosentan was evaluated. Bosentan improves dyspnea and exercise tolerance in patients with WHO Class III and IV pulmonary arterial hypertension, but requires close monitoring for liver dysfunction and drug interactions.
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