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Acute and chronic effects of sildenafil in patients with pulmonary arterial hypertension.
- Source :
-
Respiratory medicine [Respir Med] 2005 Dec; Vol. 99 (12), pp. 1501-10. - Publication Year :
- 2005
-
Abstract
- Sildenafil and inhaled nitric oxide (iNO) relax smooth muscle by inhibiting the degradation and stimulating the production of cyclic guanosine monophosphate, respectively. We compared the acute pulmonary vasodilator effects of sildenafil, iNO, and epoprostenol and asked whether the combination of iNO with sildenafil had additive pulmonary vasodilator effects. We assessed the effects of extended use of sildenafil in a small cohort of patients. Twenty patients with pulmonary arterial hypertension underwent an acute vasodilator trial with sildenafil (all patients), iNO and iNO plus sildenafil (11), and epoprostenol (19). We also provided sildenafil to patients who were ineligible for, or had clinical deterioration on epoprostenol, treprostinil, or bosentan. Mean+/-se pulmonary artery pressure dropped by 13+/-3%, 19+/-4%, 14+/-3%, and 26+/-4% with epoprostenol, iNO, sildenafil, and iNO+sildenafil, respectively. Cardiac index increased with epoprostenol and sildenafil. A correlation was found between the effects of iNO and epoprostenol. Nine out of ten patients who were started on long-term sildenafil treatment alone or in combination with other vasodilators had symptomatic improvement. Three died of right heart failure. In conclusion, sildenafil is a potent acute pulmonary vasodilator, an effect that is potentiated by combination with iNO. Long-term therapy of pulmonary hypertension with sildenafil alone or in combination with other agents appears to be safe and well tolerated.
- Subjects :
- Administration, Inhalation
Analysis of Variance
Cardiac Output drug effects
Drug Administration Schedule
Drug Therapy, Combination
Epoprostenol administration & dosage
Epoprostenol therapeutic use
Exercise Test
Female
Humans
Hypertension, Pulmonary physiopathology
Lung physiopathology
Male
Middle Aged
Nitric Oxide administration & dosage
Nitric Oxide therapeutic use
Piperazines therapeutic use
Prospective Studies
Pulmonary Artery
Purines
Sildenafil Citrate
Sulfones
Time Factors
Treatment Outcome
Vascular Resistance drug effects
Vasodilator Agents therapeutic use
Hypertension, Pulmonary drug therapy
Piperazines administration & dosage
Vasodilator Agents administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 0954-6111
- Volume :
- 99
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Respiratory medicine
- Publication Type :
- Academic Journal
- Accession number :
- 15890512
- Full Text :
- https://doi.org/10.1016/j.rmed.2005.03.026