Effects Of Sildenafil Research Articles

Sildenafil induced seizures in a patient treated for pulmonary hypertension: A case report

Sildenafil is one of the common drugs used to treat pulmonary hypertension. We report a rare case of a life-threatening adverse effect of Sildenafil. The patient was admitted to our intensive care unit for the management of urosepsis with obesity hypoventilation syndrome with pulmonary hypertension. After administration of the first dosage of Sildenafil, the patient developed generalized tonic-clonic seizure. She had no previous history of seizure disorder. She was investigated for the possible cause of seizure, but none were conclusive. Sildenafil was discontinued and she remained seizure free after discontinuation of it. Sildenafil can increase the effects mediated by nitric oxide and can thus affect the seizure threshold. Though rare, seizure as an adverse effect of Sildenafil should be considered before initiating this drug.

Sildenafil Inhibits the Growth and Epithelial-to-mesenchymal Transition of Cervical Cancer via the TGF-β1/Smad2/3 Pathway.

The study aims to explore new potential treatments for cervical cancer. Cervical cancer is the second most common cancer in women, causing >250,000 deaths worldwide. Patients with cervical cancer are mainly treated with platinum compounds, which often cause severe toxic reactions. Furthermore, the long-term use of platinum compounds can reduce the sensitivity of cancer cells to chemotherapy and increase the drug resistance of cervical cancer. Therefore, exploring new treatment options is meaningful for cervical cancer. The present study was to investigate the effect of sildenafil on the growth and epithelial-tomesenchymal transition (EMT) of cervical cancer. HeLa and SiHa cells were treated with sildenafil for different durations. Cell viability, clonogenicity, wound healing, and Transwell assays were performed. The levels of transforming growth factor-β1 (TGF-β1), transforming growth factor-β type I receptor (TβRI), phosphorylated (p-) Smad2 and p-Smad3 in cervical cancer samples were measured. TGF-β1, Smad2 or Smad3 were overexpressed in HeLa cells, and we measured the expression of EMT marker proteins and the changes in cell viability, colony formation, etc. Finally, HeLa cells were used to establish a nude mouse xenograft model with sildenafil treatment. The survival rate of mice and the tumor size were recorded. High concentrations of sildenafil (1.0-2.0 μM) reduced cell viability, the number of HeLa and SiHa colonies, and the invasion/migration ability of HeLa and SiHa cells in a dose- and time-dependent manner. The expression of TGF-β1, TβRI, p-Smad2 and p-Smad3 was significantly enhanced in cervical cancer samples and cervical cancer cell lines. Sildenafil inhibited the expression of TGF-β1-induced EMT marker proteins (Snail, vimentin, Twist, E-cadherin and N-cadherin) and p-Smad2/3 in HeLa cells. Overexpression of TGF-β1, Smad2, and Smad3 reversed the effect of sildenafil on EMT, viability, colony formation, migration, and invasion ability of HeLa cells. In the in vivo study, sildenafil significantly increased mouse survival rates and suppressed xenograft growth. Sildenafil inhibits the proliferation, invasion ability, and EMT of human cervical cancer cells by regulating the TGF-β1/Smad2/3 pathway.

Chitosan Nanoparticles Alleviated the Adverse Effects of Sildenafil on the Oxidative Stress Markers and Antioxidant Enzyme Activities in Rats.

Sildenafil (SF) is widely used for erectile dysfunction and other conditions, though with limitations regarding oral absorption and adverse effects. Despite nanotechnological improvements, the effect of nanocarriers on SF hepatotoxicity has not been documented to date. This study aimed at assessing the impact of chitosan nanoparticles either uncoated (CS NPs) or Tween 80-coated (T-CS NPs) on the effects of SF on oxidative stress markers and antioxidant enzyme activities in rats. Test SF-CS NPs prepared by ionic gelation were uniform positively charged nanospheres (diameter 178-215 nm). SF was administered intraperitoneally to male rats (1.5 mg/kg body weight) in free or nanoencapsulated forms as SF-CS NPs and T-SF-CS NPs for 3 weeks. Free SF significantly suppressed the activity of the antioxidant enzymes glutathione S-transferase (GST), glutathione peroxidase (GPx), glutathione reductase (GR), catalase (CAT), and superoxide dismutase (SOD), as well as the levels of glutathione (GSH) and thiobarbituric acid reactive substances (TBARS) as in an indirect measure of free radicals. Interestingly, SF-CS NPs and T-SF-CS-NPs treatments significantly attenuated the inhibitory effects of SF on the activity of these enzymes whereas, GST activity was inhibited. Moreover, the protein expression of GST was downregulated upon treatment of rats with free SF, SF-CS-NPs, and T-SF CS-NPs. In contrast, the activity and protein expression of GPx was induced by SF-CS NPs and T-SF-CS-NPs treatments. The histopathological study showed that SF induced multiple adverse effects on the rat liver architecture which were markedly suppressed particularly by T-SF-CS NPs. In conclusion, chitosan nanoencapsulation of SF counteracted the adverse effects of SF on the activity of antioxidant enzymes and liver architecture. Findings might have significant implications in improving the safety and efficacy of SF treatment of the widely expanding disease conditions.

Nrf2 and NF-қB interplay in tamoxifen-induced hepatic toxicity: A promising therapeutic approach of sildenafil and low-dose γ radiation.

Tamoxifen-induced hepatotoxicity is an inevitable side effect during breast cancer treatment. Low-dose gamma irradiation (IRR) shows many beneficial effects by stimulating various biological processes. This study evaluates the possible effect of sildenafil and low-dose gamma radiation on liver damages as new treatment strategies. Group I (control), group II: (tamoxifen), group III: (tamoxifen + Sildenafil), group IV: (tamoxifen+ irradiation) and group V: (tamoxifen +Sildenafil + irradiation). Rats were sacrificed after 5h from tamoxifen injection. Results showed that tamoxifen caused elevation in serum AST, ALT and ALP as well hepatic ROS, iNOS, MDA, Keap-1 and NF-Kb, in addition to diminution in hepatic Nrf2 and HO-1. Exposure to low-dose gamma radiation and sildenafil amended the alterations in the measured parameters in serum and tissue. Moreover, all results were confirmed by histopathological examination. In conclusion, sildenafil and low-dose gamma radiation can mitigate the toxicity induced by tamoxifen in liver tissues. Hence, this treatment could be further evaluated as a new approach for alleviating various liver disorders.

The Effects of Different Doses of Sildenafil on Coronary Blood Flow and Oxidative Stress in Isolated Rat Hearts.

The dose-response relationship of sildenafil effects on cardiac function is not completely elucidated. The aim of this study was to assess the effects of different doses of sildenafil on coronary flow and oxidative stress in isolated rat hearts. Coronary flow and markers of oxidative stress, including nitrite outflow, and superoxide anion production in coronary effluent, were determined for isolated rat hearts. The experiments were performed during control conditions and in the presence of sildenafil (10, 20, 50, 200 nM) alone or with Nω-nitro-L-arginine monomethyl ester (L-NAME) (30 μM). Sildenafil was shown to result in a significant increase in coronary flow at lower coronary perfusion pressure (CPP) values at all administered doses, whereas, with an increase in CPP, a reduction in coronary flow was observed. An increase in nitric oxide (NO) was most pronounced in the group treated with the lowest dose of sildenafil at the highest CPP value. After the inhibition of the NO-cyclic guanosine monophosphate (cGMP) signaling (NOS) system by L-NAME, only a dose of 200 nM sildenafil was high enough to overcome the inhibition and to boost release of O2-. That effect was CPP-dependent, with statistical significance reached at 80, 100 and 120 mmHg. Our findings indicate that sildenafil causes changes in heart vasculature in a dose-dependent manner, with a shift from a vasodilatation effect to vasoconstriction with a pressure increase. The highest dose administered is capable of producing superoxide anion radicals in terms of NOS system inhibition.

Oral Sildenafil in the Treatment of Cystic Hygroma in Infant

Introduction: Cystic hygroma is a type of cyst that occurs when lymphatic fluid collects in the lymph nodes which occurs in infants and can cause significant swelling in the neck or other parts of the body. Sildenafil is a possible medication that can be used to treat erectile dysfunction in infant. Aim of the study: The aim of this study was to assess the effectiveness of oral sildenafil in the treatment of cystic hygroma in infant. Methods: This retrospective study was conducted from January 2020 to June 2022 in The Division of Pediatric Surgery, Bangladesh Shishu Hospital & Institute and three other private clinics at Dhaka. Total 55 patients (aged between 2 months to 1 year) with cystic hygroma were included in the study. Result: In the present study, the median (Range) age of 55 patients was 6.2 (2-12) months. The median (Range) weight of 55 patients was 6.5 (4-12) kg. In this study, majority (60%) of the patients were male. More than half (52.73%) patients had the lesion on neck. The median (Range) pretreatment size of lesion was 13.30 (9.88-16.93) cm2. The median pretreatment size of lesion was 13.30 cm2 and median post treatment size of lesion was 0.00 cm2. There was highly significant difference (p <0.001) between pre-treatment and post-treatment size. In this study, excellent response was found in 69.09% patients, good response was found in 21.82% patients. In the current study, 3 patients (5.45%) had cough, 4 patients (7.27%) had fever, 2 patients (3.64%) had rhinorrhoea and 3 patients (5.45%) had vomiting. In the current study, 12 (21.82%) patients had adverse effects. Cost of sildenafil per tablet was 34 cents (100 cents =1 $). Conclusion: Oral sildenafil resulted excellent size regression and low adverse effects for the treatment of cystic hygroma. It was also very cost effective and convenient to administer.

Abstract 2500: The Effect of Sildenafil on Atrial Natriuretic Peptide Level in Rats Treated with Monocrotaline

Abstract 2500: The Effect of Sildenafil on Atrial Natriuretic Peptide Level in Rats Treated with Monocrotaline

Review - Combinatory approaches targeting cognitive impairments and memory enhancement.

The objective of this paper is to look at how natural medicines can improve cognition and memory when used with sildenafil, a popular erectile dysfunction medicine that also has nootropic properties. Newer treatment strategies to treat the early stages of these diseases need to be developed. Multiple factors lead to complex pathophysiological conditions, which are responsible for various long-term complications. In this review a combination of treatments targeting these pathologies are discussed. These combinations may help manage early and later phases of cognitive impairments. The purpose of this article is to discuss a link between these pathologies and a combinational approach with the objective of considering newer therapeutic strategies in the treatment of cognitive impairments. The natural drugs, and their ingredients play a major role in the management of disease progression. Additionally, their combination with sildenafil allows for more efficacy and better response. Studies showing effectiveness of natural drugs and sildenafil are mentioned and how the combinations could be beneficial for treatment of cognitive impairments and amnesia are summarised. Furthermore, preclinical and clinical trials are required to explore the medicative potential of these drug combinations.

PS-B04-5: AMELIORATIVE POTENTIAL OF COMBINATION OF VITAMIN D AND SILDENAFIL AGAINST MONOCROTALINE-INDUCED PULMONARY HYPERTENSION IN RATS VIA ACTIVATING ENOS

Objective: The life expectancy in PAH is very less, and only symptomatic treatment is available. Patients with pulmonary hypertension are mostly diagnosed with co-existing vitamin D deficiency. In PAH, there is an increase in the level and expression of PDE 5 enzyme that results in increased degradation of cGMP but there is also a simultaneous decrease in the activation of cGMP due to a subsequent decrease in eNOS mediated nitric oxide synthesis. Thus, limiting the efficacy of sildenafil as monotherapy in the treatment of PAH. Furthermore, vitamin D deficiency is also associated with reduced expression of eNOS mediated NO synthesis, which further decreases cGMP synthesis thus increasing disease severity. Hence, this study was undertaken to study the combined effect of sildenafil and vitamin D therapy in monocrotaline-induced PAH in rats. Design and method: Rats were fed on a vitamin D deficient diet with exposure to filtered fluorescent light to induce vitamin D deficiency. PAH was induced by a single s.c. injection of MCT 50 mg/kg. Rats were divided into 6 groups: Control, MCT, MCT+Sildenafil, MCT+Vitamin D, MCT+Vitamin D+Sildenafil and MCT+L-NAME+Vitamin D+Sildenafil. Haemodynamic, echocardiographic, histopathological and biochemical parameters were analysed. The expression and level of eNOS was done using immunohistochemistry and western blot. Results: The effect of the vitamin D sildenafil combination group was significantly higher than the vitamin D and sildenafil treated alone groups. This protective effect of vitamin D sildenafil combination in PAH is attenuated when administered with L-NAME (20 mg/kg). Furthermore, the administration of MCT reduced the expression of eNOS, which was significantly reversed by the treatment with vitamin D sildenafil combination compared to vitamin D and sildenafil alone. Conclusion: The effect of vitamin D in the treatment of PAH is comparable to sildenafil alone and is further improved when given in combination with sildenafil. Moreover, if pulmonary hypertension is accompanied by vitamin D deficiency it results in increased disease severity of PAH. Thus, sildenafil when combined with vitamin D may exert a synergistic effect in amelioration of symptoms and disease severity in patients of pulmonary hypertension.

Retracted: The Levels of TNF-α, Tissue Factor, and Coagulation Function in Rats with Pulmonary Hypertension and the Intervention Effect of Sildenafil Encapsulated by Targeted Nanocarriers.

[This retracts the article DOI: 10.1155/2022/8619092.].

Применение селективного ингибитора фосфодиэстеразы–5 силденафила при беременности с учетом его возможного влияния на плод

Objective of the Review: To evaluate the possibilities and effectiveness of the use of sildenafil in obstetric practice, its effect on both the fetus and the mother's body. Key points. Sildenafil is a potent vasodilator drug used to treat pulmonary hypertension in adults and children. In addition to the vasodilating effect, sildenafil has a proliferative effect on the vascular network, reduces the muscle mass of the vascular wall. The vasodilating effect of sildenafil also appears on the uterus and myometrial vessels, which leads to increased uterine circulation and thickening of the endometrium. Its use during pregnancy is mainly limited to a few specific indications. In particular, high pulmonary hypertension – is sufficient reason to prescribe this drug off–label even at the stage of pregnancy planning. To date, antenatal therapy with sildenafil for conditions such as preeclampsia, preterm labor, oligohydramnios, congenital diaphragmatic hernia, intranatal fetal distress, and intrauterine growth restriction are being actively studied in many countries. More than 130 in vivo and ex vivo animal studies, pharmacological and toxicokinetic studies have demonstrated the safety of sildenafil. It has been proven that there is no teratogenic effect, as well as an increase in the frequency of congenital anomalies in the fetus. Conclusion. The use of sildenafil during pregnancy is of interest to researchers around the world. Based on preliminary data, it can be assumed that serious side effects in pregnant women, negative effects on the fetus, an increase in the frequency of stillbirths, neonatal deaths and congenital anomalies associated with taking sildenafil were not observed. However, additional fundamental studies are needed, including using experimental animal models, in order to finally evaluate the ability of sildenafil to overcome the transplacental barrier, as well as the possibility and effectiveness of its use in various groups of patients. Keywords: sildenafil, transplacental transfer, safety during pregnancy, pharmacology, hemodynamics.

Quercetin potentiates the hepatoprotective effect of sildenafil and/or pentoxifylline against intrahepatic cholestasis: Role of Nrf2/ARE, TLR4/NF-κB, and NLRP3/IL-1β signaling pathways

AimIntrahepatic cholestasis is a common pathological condition of several types of liver disorders. In this study, we aimed to investigate the regulatory effects of quercetin (QU) on selected phosphodiesterase inhibitors against alpha-naphthyl isothiocyanate (ANIT)-induced acute intrahepatic cholestasis. MethodsCholestasis was induced in Wistar albino rats by ANIT as a single dose (60 mg/kg; P·O.). QU (50 mg/kg, daily, P·O.), sildenafil (Sild; 10 mg/kg, twice daily, P·O.), and pentoxifylline (PTX; 50 mg/kg, daily, P.O.) were evaluated either alone or in combinations for 10 days for their antioxidant, anti-inflammatory, and anti-pyroptotic effects. ResultsANIT produced a prominent intrahepatic cholestasis as evidenced by a significant alteration in liver functions, histological structure, inflammatory response, and oxidative stress biomarkers. Furthermore, up-regulation of NF-κB-p65, TLR4, NLRP3, cleaved caspase-1, IKK-β, and IL-1β concurrently with down-regulation of Nrf-2, HO-1, and PPAR-γ expressions were observed after ANIT. QU, Sild, or PTX treatment significantly alleviated the disturbance induced by ANIT. These findings were further supported by the improvement in histopathological features. Additionally, co-administration of QU with Sild or PTX significantly improved liver defects due to ANIT as compared to the individual drugs. SignificanceCombined QU with Sild or PTX exhibited promising hepatoprotective effects and anti-cholestatic properties through modulation of Nrf2/ARE, TLR4/NF- κB, and NLRP3/IL-1β signaling pathways.

Congenital diaphragmatic hernia: phosphodiesterase-5 and Arginase inhibitors prevent pulmonary vascular hypoplasia in rat lungs.

Severe pulmonary hypoplasia related to congenital diaphragmatic hernia (CDH) continues to be a potentially fatal condition despite advanced postnatal management strategies. To evaluate the effect of the antenatal sildenafil and 2(S)-amino-6-boronohexanoic acid (ABH-Arginase inhibitor) on lung volume, pulmonary vascular development, and nitric oxide (NO) synthesis in a Nitrofen-induced CDH rat model. Nitrofen-induced CDH rat model was used. Nitrofen was administrated on embryonic day(E) 9,5. At E14, five intervention groups were treated separately: Nitrofen, Nitrofen+Sildenafil, Nitrofen+ABH, Nitrofen+Sildenafil+ABH and Control. At term, offspring's lungs were weighed, some paraffin-embedded for histology, others snap-frozen to analyze eNOS, Arginase I-II expression, and activity. In CDH-bearing offsprings, ABH or Sildenafil+ABH preserved the total lung/body-weight index (p < 0.001), preventing pulmonary vascular smooth muscle cell hyperproliferation and improving lung morphometry. Sildenafil+ABH increased 1.7-fold the lung nitrite levels (p < 0.01) without changes in eNOS expression. Sildenafil and ABH improved the number of pulmonary vessels. These results suggest that in this CDH rat model, the basal activity of Arginase participates in the lung volume and, together with phosphodiesterase-5, regulates NOS activity in the term fetal lung. The combined treatment (Sildenafil+ABH) could revert some of the pulmonary features in CDH by improving the local NO synthesis and preventing smooth muscle cell hyperproliferation. This study presents Arginase inhibition as a new therapeutic target and the importance of the combined antenatal treatment to improve pulmonary vascular development in a congenital diaphragmatic hernia (CDH) rat model. This study shows that the action of an Arginase inhibitor (ABH) enhances the effects already described for sildenafil in this model. These results reinforce the importance of prenatal treatments' synergy in recovering the hypoplastic lung in the Nitrofen-induced CDH rat model.

Safety of sildenafil in premature infants at risk of bronchopulmonary dysplasia: Rationale and methods of a phase II randomized trial

Bronchopulmonary dysplasia (BPD) is a disease of chronic respiratory insufficiency stemming from premature birth and iatrogenic lung injury leading to alveolar simplification, impaired alveolar-capillary development, interstitial fibrosis, and often pulmonary hypertension. BPD is the most common pulmonary sequela of prematurity and is often fatal; however, there remains no FDA-approved therapies to treat or prevent BPD. Sildenafil is increasingly used off-label in premature infants despite scant safety and efficacy data. Sildenafil reduces lung injury and preserves normal vasculature in preclinical models, and improves outcomes in children with pulmonary hypertension, and thus is a promising candidate for BPD. Following phase I studies, we developed the phase II SIL02 trial to describe the safety, pharmacokinetics and preliminary effectiveness of intravenous and enteral sildenafil in premature infants at risk for BPD. SIL02 is a randomized, double-blind, placebo-controlled, 3-cohort, sequential dose-escalating trial of enteral or intravenous (IV) sildenafil dosed every 8 h for up to 34 days. The target IV doses were 0.125, 0.5 and 1 mg/kg/dose in cohorts 1, 2 and 3, respectively; while the enteral doses will be double the IV doses. Eligible infants must be < 29 weeks' gestation at birth and requiring respiratory support at 7–28 days' postnatal age. Adverse events and preliminary effectiveness will be compared by treatment group. Using the final population PK model, empirical Bayesian estimates will be generated for each patient. Preliminary effectiveness will be measured by the incidence of moderate to severe BPD or death at 36 weeks and change in the BPD risk estimation.

Evaluation of drug interactions of saxagliptin with sildenafil in healthy volunteers

PurposeThe purpose of this study is to investigate the effect of sildenafil a CYP3A4 substrate and inhibitor on the pharmacokinetics and safety of saxagliptin. MethodsEighteen healthy volunteers were recruited in sequential; single-center study to determine pharmacokinetic parameters of saxagliptin and sildenafil, and (AUC0-∞), (AUC0-t); Cmax; tmax; t½, ke; ka were measured using validated LC–MS/MS method. Therapeutic doses were given as follows: Sildenafil 50 mg single dose on day one, then washout period from day two till day eight. Saxagliptin 5 mg once/day was given from day 9 till day 12; then on day 13, the two drugs were co-administered. Blood samples for pharmacokinetic analysis were collected on days 1 and 13 for sildenafil and on days 12 and 13 for saxagliptin.ResultsSaxagliptin ratios of T/R and 90% CI were 132.1% (122.7–142.3) for AUC0–t, and 167.6% (154.6–181.8) for Cmax. On the other hand, sildenafil pharmacokinetics were not affected. Gmax changed from 93.7 mg/dl to 95.6 mg/dl (P > 0.001) and AUCg0-t from 512.8 ng.h/ml to 532.75 ng.h/ml (P > 0.001) after co-administration of both drugs.ConclusionSildenafil significantly affected the pharmacokinetic parameters of saxagliptin when co-administered.RegistrationThis trial was registered at clinicaltrials.gov under identifier number: [NCT04170790] in November 2019.

The Effect Of Aspirin and Sildenafil on Endometrial Thickness, Oocyte Characteristic, Embryo quality and Pregnancy test in Iraqi Infertile Women Undergoing Intracytoplasmic Sperm Injection

Infertile couples undergoing Assisted Reproductive techniques are really receptive to any intervention intended to enhancement their fertility. Successful implantation of an embryo requires a receptive endometrium, a good quality embryo, and embryo endometrial synchronization in all species. Pharmacological agents such as aspirin and sildenafil have been included in previous clinical trials to improve endometrial vascularity and perifollicular blood flow but the results were inconsistent. To evaluate the effect of oral low dose aspirin or vaginal sildenafil citrate on endometrial thickness, retrieved oocyte, degree of maturation, embryo quality and pregnancy test. This comparative prospective study was conducted on the 60 infertile women who participated in intracytoplasmic sperm injection (ICSI) cycles at the infertility clinic associated with the "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al- Nahrain University / Baghdad/ Iraq." December 2020 to June 2022. In the present study the count of total oocytes retrieved was significantly higher in aspirin treated group in comparison to sildenafil treated group 12.5 ±5.3 versus 9.37 ±5.5 respectively. No significant variation in mean endometrial thickness among study groups. Regarding biochemical pregnancy test, positive results were obtained in 12 (40.0 %), 10 (33.3 %) in aspirin treated group, sildenafil treated group respectively and the difference was not significant. Aspirin treatment resulted in higher number of total retrieved oocytes, aspirin and sildenafil did not improve endometrial thickness, but they resulted in improvement of sub endometrial vascularity; however, biochemical pregnancy test was not affected by either pharmacological agent

PDE5 inhibitors and male reproduction: Is there a place for PDE5 inhibitors in infertility clinics or andrology laboratories?

The objective of this review study is to evaluate the therapeutic role of PDE5 inhibitors (PDE5is) in the amelioration of oligoasthenospermia in infertile males. PDE5is have a beneficial influence on the secretory function of the Leydig and Sertoli cells, the biochemical environment within the seminiferous tubule, the contractility of the testicular tunica albuginea, and the prostatic secretory function. In several studies, the overall effect of sildenafil and vardenafil increased quantitative and qualitative sperm motility. Furthermore, some studies indicate that PDE5is influence positively the sperm capacity to undergo capacitation under biochemical conditions that are known to induce the sperm capacitation process. Additional research efforts are necessary in order to recommend unequivocally the usage of sildenafil, vardenafil, or avanafil for the alleviation of male infertility.

Comparison of the Effectiveness of Bosentan and Sildenafil in the Management of Persistent Pulmonary Arterial Hypertension in Neonates

Comparison of the Effectiveness of Bosentan and Sildenafil in the Management of Persistent Pulmonary Arterial Hypertension in Neonates

Effectiveness of Low Dose Aspirin or Vaginal Sildenafil on Perifollicular Blood Flow Using Doppler ultrasound and EG-VEGF and their Impacts on ICSI Cycle Outcome

Effectiveness of Low Dose Aspirin or Vaginal Sildenafil on Perifollicular Blood Flow Using Doppler ultrasound and EG-VEGF and their Impacts on ICSI Cycle Outcome

The use of bosentan and sildenafil as rescue therapy in persistent pulmonary hypertension of the newborn: A single center's experience

BackgroundPersistent pulmonary hypertension of the newborn (PPHN) is a serious condition characterized by elevation of pulmonary vascular resistance. Pulmonary vasodilators are currently used as a rescue therapy or combined with inhaled nitric oxide in patients with PPHN. ObjectiveThis study aimed to determine the effect of bosentan and sildenafil on the oxygenation and short-term adverse events of patients with PPHN. MethodsA retrospective study was conducted in neonates diagnosed with PPHN and received bosentan or sildenafil therapy between 2010 and 2017 at the neonatal intensive care unit of tertiary referral hospital in Thailand. ResultsA total of 31 neonates with PPHN were included in this study. The median (IQR) gestation age and mean ± SD birth weight were 38 (36–40) weeks and 2961 ± 888 g, respectively. Of the 31 neonates, 16 received bosentan and 15 received sildenafil treatment. The initial mean oxygen index (OI) in the bosentan group was 18.7 ± 16.7, which decreased significantly at 24 h after treatment (OI = 8.5 ± 6.3, p < 0.001). In the sildenafil group, the initial mean OI was 47.1 ± 33.2, which decreased dramatically at 24 h after treatment (OI = 23.4 ± 19.5, p < 0.001). Oxygen saturation significantly improved at 96 h of bosentan and 36 h of sildenafil treatment, respectively. Blood pressure before and after treatment were not significantly different changed in both groups. ConclusionsBosentan and sildenafil are effective pulmonary vasodilators that are safe in PPHN treatment. Both drugs can be used as a rescue therapy in patients with PPHN, especially in centers lacking inhalable nitric oxide.