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Infectious Disease Reports
Volume 7
Issue 1
10.4081/idr.2015.5822
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Case Report

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

by
Pierangelo Chinello
1,*,
Stefania Cicalini
1,
Simona Pichini
2,
Roberta Pacifici
2,
Massimo Tempestilli
3,
Maria P. Cicini
4,
Leopoldo P. Pucillo
3 and
Nicola Petrosillo
1
1
Second Infectious Diseases Unit, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
2
Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation, National Institute of Health, Rome, Italy
3
Clinical Biochemistry and Pharmacology Laboratory, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
4
III Cardiology Unit, S. Camillo-Forlanini Hospital, Rome, Italy
*
Author to whom correspondence should be addressed.
Infect. Dis. Rep. 2015, 7(1), 5822; https://doi.org/10.4081/idr.2015.5822
Submission received: 22 January 2015 / Revised: 18 February 2015 / Accepted: 20 February 2015 / Published: 16 March 2015

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.
Keywords: human immunodeficiency virus; protease inhibitors; pulmonary arterial hypertension; sildenafil; bosentan human immunodeficiency virus; protease inhibitors; pulmonary arterial hypertension; sildenafil; bosentan

Share and Cite

MDPI and ACS Style

Chinello, P.; Cicalini, S.; Pichini, S.; Pacifici, R.; Tempestilli, M.; Cicini, M.P.; Pucillo, L.P.; Petrosillo, N. Sildenafil and bosentan plasma concentrations in a human immunodeficiency virus-infected patient with pulmonary arterial hypertension treated with ritonavir-boosted protease inhibitor. Infect. Dis. Rep. 2015, 7, 5822. https://doi.org/10.4081/idr.2015.5822

AMA Style

Chinello P, Cicalini S, Pichini S, Pacifici R, Tempestilli M, Cicini MP, Pucillo LP, Petrosillo N. Sildenafil and bosentan plasma concentrations in a human immunodeficiency virus-infected patient with pulmonary arterial hypertension treated with ritonavir-boosted protease inhibitor. Infectious Disease Reports. 2015; 7(1):5822. https://doi.org/10.4081/idr.2015.5822

Chicago/Turabian Style

Chinello, Pierangelo, Stefania Cicalini, Simona Pichini, Roberta Pacifici, Massimo Tempestilli, Maria P. Cicini, Leopoldo P. Pucillo, and Nicola Petrosillo. 2015. "Sildenafil and bosentan plasma concentrations in a human immunodeficiency virus-infected patient with pulmonary arterial hypertension treated with ritonavir-boosted protease inhibitor" Infectious Disease Reports 7, no. 1: 5822. https://doi.org/10.4081/idr.2015.5822

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