Chest
Volume 123, Issue 4, April 2003, Pages 1293-1295
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Selected Reports
Long-term Treatment With Oral Sildenafil in Addition to Continuous IV Epoprostenol in Patients With Pulmonary Arterial Hypertension

https://doi.org/10.1378/chest.123.4.1293Get rights and content

Objectives:

To evaluate the effect of long-term oral therapy with sildenafil in patients with pulmonary arterial hypertension receiving long-term IV epoprostenol.

Design:

Open, uncontrolled trial.

Setting:

University hospital.

Patients:

Two patients with primary pulmonary hypertension and one patient with pulmonary arterial hypertension after surgical closure of an atrial septal defect. All patients were receiving continuous epoprostenol for 1.7 to 7.1 years; two patients also received inhaled iloprost for 1.8 years and 3.8 years, respectively.

Interventions:

Addition of oral sildenafil, up to 200 mg/d, divided in four to six single doses, and hemodynamic measurements and the 6-min walking distance (6MWD) before and after 5 months of treatment with sildenafil.

Results:

One patient was treated with sildenafil, 200 mg/d; two patients received 75 mg/d due to nausea and headache. Long-term treatment with sildenafil in the three patients reduced mean pulmonary artery pressure by 14%, 41%, and 22%, respectively; in two patients, pulmonary vascular resistance was decreased by 52% and 55%. The 6MWD increased by 34%, 6%, and 29%, respectively. No significant systemic hypotension or decrease of arterial oxygen saturation was seen.

Conclusion:

Sildenafil therapy may be of benefit in patients with pulmonary arterial hypertension receiving long-term infusion of epoprostenol.

Section snippets

Materials and Methods

For measurements of hemodynamic and gas exchange parameters, a thermodilution pulmonary artery catheter was inserted before and after 5 months treatment with sildenafil. A 6-min walking test (6MWT) was performed before and after the sildenafil trial. The dose of epoprostenol and iloprost was not changed in the 3 months before and during the sildenafil trial. The 6MWT distance and the hemodynamic measurements were made before the administration of sildenafil and iloprost. The study was approved

Discussion

Addition of sildenafil to the long-term therapy with IV epoprostenol improved pulmonary arterial pressures and the 6MWT distance in all three patients without significant adverse effects at the reported doses. IV epoprostenol is now established as a treatment to be considered for all patients with PPH, and hundreds of patients worldwide experienced the beneficial effect of this treatment. Introduced initially as a bridge to transplantation, it is now considered superior to lung transplantation

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There are more references available in the full text version of this article.

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