Impacto do sildenafil sublingual na hipertensão pulmonar de pacientes com insuficiência cardíaca

Freitas, Adriana Rodrigues de; Bacal, Fernando; Oliveira, José De; Santos, Ronaldo Honorato Barros; Moreira, Luíz Felipe Pinho; Silva, Christiano Pereira; Mangini, Sandrigo; Carneiro, Rodrigo Moreno Dias; Fiorelli, Alfredo Inácio; Bocchi, Edimar Alcides

doi:10.1590/s0066-782x2009000200008

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…In patients with end-stage heart failure, sublingual sildenafil decreases pulmonary pressure by approximately 20% [13]. Altogether, these results confirm rapid mucosal absorption.…”

Section: Discussionmentioning

confidence: 71%

Substantially increased sildenafil bioavailability after sublingual administration in children with congenital heart disease: two case reports

et al. 2014

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IntroductionPulmonary hypertension is a progressive disease of diverse origin with devastating consequences in adults as well as in children. The phosphodiesterase 5 inhibitor sildenafil successfully lowers pulmonary vascular resistance. However, because of its poor enteral absorption, resulting in ineffective plasma concentrations, responses in infants and children are often erratic.Case presentationsWe report the cases of two Caucasian boys, one born at term (case 1) and one aged 2.5 years (case 2), who had structural cardiac and pulmonary defects accompanied by symptomatic pulmonary hypertension. They received sildenafil enterally and sublingually and also intravenously in one of them. Plasma samples were taken at various time points to determine the plasma concentrations of sildenafil and its partially active metabolite. Sildenafil and N-desmethyl sildenafil were quantified using a validated liquid chromatography/mass spectrometry method. Oxygen partial pressure was determined from routine arterial blood gas samples.ConclusionIn agreement with previous observations in adults, we found that sublingual sildenafil was more extensively absorbed in our two pediatric patients. After sublingual administration, sildenafil plasma concentrations increased by 314% to 361% compared to enteral dosing. Concurrently, the metabolic ratio increased, suggesting not only that the overall absorption was enhanced but also that first-pass metabolism was partially bypassed. In case 2, the free fraction of sildenafil was 0.9%, which is considerably less than in adults (4%), suggesting that, in case 2, higher plasma concentration would have been needed to achieve effects similar to those in adults. Sublingual sildenafil appears to be a promising alternative route of administration in children with poor enteral absorption.

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“…In patients with end-stage heart failure, sublingual sildenafil decreases pulmonary pressure by approximately 20% [13]. Altogether, these results confirm rapid mucosal absorption.…”

Section: Discussionmentioning

confidence: 71%

Substantially increased sildenafil bioavailability after sublingual administration in children with congenital heart disease: two case reports

et al. 2014

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“…For several years, sildenafil has also been used for the study of PH reversibility in patients being assessed for HT ( 6 , 7 ). In these cases, oral sublingual administration is adopted.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Sildenafil in Right Ventricular Dysfunction with Pulmonary Hypertension following a Heart Transplant

Bonet

Guillén

Lázaro

et al. 2014

Heart International

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The objective of the present work is to describe the experience with intravenous (IV) sildenafil in heart transplant (HT) patients with reactive pulmonary hypertension (PH) who developed right ventricular dysfunction (RVD) in the immediate postoperative period. The first 5 patients who received IV sildenafil followinga HT are presented. The HTs took place between March 2011 and September 2012 in patients aged 37 to 64 years; all patients were male. Prior to the HT, mean pulmonary artery pressure (mPAP) was 32-56 mmHg. In all cases, the hemodynamic study demonstrated PH reactivity (positive vasodilator test with nitric oxide). All 5 patients developed RVD with hemodynamic instability immediately after the HT, despite the administration of nitric oxide from the time of intubation prior to the implant, optimal medical treatment in all cases, and a ventricular assist in 2 cases. In all patients, IV sildenafil was initiated at 10 mg/8 h for 48 h and was subsequently increased to 20 mg/8 h. in its oral formulation until discharge from the hospital. The change in pulmonary pressure was assessed using a Swan-Ganz catheter. Ventricular function was assessed using echocardiography. Length of stay in the Resuscitation Unit and mid-term survival were also assessed.Average time of extracorporeal circulation was 200 ± 110 min and organ ischemic time was 210 ± 95 min. All of the patients demonstrated pulmonary and systemic hemodynamic improvement, as well as recovery of right ventricular function after completing the treatment with IV sildenafil. The stay in the Resuscitation Unit lasted 3-25 days. All the patients were discharged from hospital with no mortality to date. Intravenous sildenafil improves right ventricle hemodynamics associated with pulmonary hypertension post-HT. Prophylactic prevention with this drug could be indicated for patients with reactive PH who are about to receive a transplant.

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“…7 Thus, proposals for new therapies and improvements in the existing therapies have been seen, resulting in significantly better treatment and management for heart failure patients. Among these techniques, the development of new medications and pharmacological regimens, 8,9 cardiac resynchronization therapy, 10 mechanical devices to assist the circulation, cell therapy, 11 cardiovascular rehabilitation programs with exercises 4 and thoracic sympathectomy, 12 among others, can be highlighted. Within this context, heart surgery has an important role.…”

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confidence: 99%

Surgical treatment of heart failure: a hot topic

Pêgo-Fernandes

Monteiro

2011

Sao Paulo Med. J.

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Impacto do sildenafil sublingual na hipertensão pulmonar de pacientes com insuficiência cardíaca

Abstract: SummaryBackground: Pulmonary hypertension (PH) is a factor of poor prognosis in the postoperative period of heart transplant (HT) and thus, the study of the degree of reversibility to vasodilators is mandatory during the preoperative assessment.

Cited by 11 publications

References 18 publications

Substantially increased sildenafil bioavailability after sublingual administration in children with congenital heart disease: two case reports

Substantially increased sildenafil bioavailability after sublingual administration in children with congenital heart disease: two case reports

Intravenous Sildenafil in Right Ventricular Dysfunction with Pulmonary Hypertension following a Heart Transplant

Surgical treatment of heart failure: a hot topic

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