Abstract
BackgroundAmbrisentan is a selective endothelin receptor antagonist used for the treatment of pulmonary arterial hypertension (PAH). Little is known about ambrisentan removal by hemodialysis in patients with end-stage renal disease (ESRD).Case presentationA 53-year-old woman with HIV/hepatitis C virus (HCV) co-infection, PAH and ESRD on regular hemodialyis was admitted in our hospital due to refractory heart failure while on treatment with bosentan (125 mg twice daily) and tadalafil (20 mg once daily) for PAH and antiretroviral treatment (cART) including darunavir/cobicistat (800/150 mg once daily). Excessive exposure to bosentan due to drug interactions between bosentan and darunavir/cobicistat was suspected. Bosentan was replaced by ambrisentan, with progressive improvement in her clinical condition. Pre- and postdialyzer cocentrations of ambrisentan in plasma were determined and hemodialysis extraction ratio for ambrisentan was 2%.ConclusionsOur results suggest that hemodialysis results in minimal ambrisentan removal, and therefore no specific ambrisentan dosage adjustment seems to be required in ESRD patients undergoing hemodialysis.
Highlights
Ambrisentan is a selective endothelin receptor antagonist used for the treatment of pulmonary arterial hypertension (PAH)
Our results suggest that hemodialysis results in minimal ambrisentan removal, and no specific ambrisentan dosage adjustment seems to be required in end-stage renal disease (ESRD) patients undergoing hemodialysis
We report a clinical case involving an HIV-1infected patient with severe PAH and ESRD on hemodialysis who was treated with ambrisentan with the intention to avoid drug interactions between bosentan and combined antiretroviral therapy (cART)
Summary
Our results suggest that hemodialysis results in minimal ambrisentan removal, and no specific ambrisentan dosage adjustment seems to be required in ESRD patients undergoing hemodialysis.
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