Ambrisentan use in a HIV-1 infected patient with end-stage renal disease and pulmonary hypertension: minimal removal by hemodialysis - a case report

Abstract

Background: Ambrisentan 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 presentation: A 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%. Conclusions: Our 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.

Endothelin and the Cardiovascular System: The Long Journey and Where We Are Going

“…Although no difference in pulmonary vascular resistance reduction was found between upfront double and triple therapy, an exploratory analysis showed a potential reduction in disease progression, albeit with a small sample size [153]. Obviously, ambrisentan and/or macitentan have also been analyzed for PAH due to various etiological causes, such as HIV, CHD, or hepatopulmonary hypertension, with varying degrees of success or lack thereof, in the case of the MAESTRO study on Eisenmenger syndrome [154][155][156].…”