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Drug Interactions With Bosentan

More Detail on Drug Interactions With Bosentan

The following sections explain in detail the potentially negative interactions that can occur when bosentan is combined with any of the drugs listed above.
 
Cyclosporine
Cyclosporine can significantly increase bosentan blood levels, increasing the risk for serious side effects. In addition, bosentan can decrease blood levels of cyclosporine. These medications should not be taken together.
 
CYP 2C9 Inducer Medications
The liver breaks down bosentan using enzymes known as CYP 2C9 enzymes, and medications known as CYP 2C9 inducers can increase the activity of these enzymes. Thus, combining bosentan with one of these drugs may decrease the level of bosentan in your body, possibly making it less effective. Talk to your healthcare provider about this potential interaction before taking these drugs together.
 
CYP 2C9 Inhibitor Medications
The liver breaks down bosentan using enzymes known as CYP 2C9 enzymes, and medications known as CYP 2C9 inhibitors can decrease the activity of these enzymes. Thus, combining bosentan with one of these drugs may increase the level of bosentan in your body, potentially increasing your risk for side effects. Talk to your healthcare provider before taking these drugs together. In some cases, this combination will need to be avoided.
 
CYP 3A4 Inducer Medications
The liver breaks down bosentan using enzymes known as CYP 3A4 enzymes, and medications known as CYP 3A4 inducers can increase the activity of these enzymes. Thus, combining bosentan with one of these drugs may decrease the level of bosentan in your body, possibly making it less effective. Talk to your healthcare provider about this potential interaction before taking these drugs together.
 
CYP 3A4 Inhibitor Medications
The liver breaks down bosentan using enzymes known as CYP 3A4 enzymes, and medications known as CYP 3A4 inhibitors can decrease the activity of these enzymes. Thus, combining bosentan with one of these drugs may increase the level of bosentan in your body, potentially increasing your risk for side effects. Talk to your healthcare provider before taking these drugs together. In some cases, this combination will need to be avoided.
 
Glyburide
Bosentan may decrease blood levels of glyburide, which could cause your blood glucose (blood sugar) to increase. Glyburide can decrease blood levels of bosentan, potentially making it less effective. In addition, combining bosentan with glyburide has been reported to increase the risk for elevated liver enzymes, which could be a sign of liver damage. These medicines should not be taken together.
 
Hormonal Contraceptives
Bosentan can make hormonal birth control products less effective. This includes any birth control that relies on hormones to work, such as birth control pills, patches, injections, and implants. Because bosentan can harm an unborn child, it is important to talk to your healthcare provider about the best birth control method to use during treatment.
 
Ketoconazole
Ketoconazole may increase blood levels of bosentan, possibly increasing the risk for side effects. Talk to your healthcare provider before taking these medications together.
 
Rifampin
Rifampin may increase blood levels of bosentan within the first few weeks of treatment, but then appears to decrease blood levels. If you take these medicines together, your healthcare provider will need to monitor your liver function using blood tests weekly for the first four weeks, because high bosentan blood levels increase the risk for liver problems. 
 
Ritonavir or Lopinavir and Ritonavir
Ritonavir increases blood levels of bosentan, which could increase the risk for side effects. People who are taking ritonavir-containing medications should generally be started on lower bosentan doses. For people who are already taking bosentan but will be starting a ritonavir medicine, bosentan should be stopped at least 36 hours before the first dose of ritonavir and then restarted at a lower dose (62.5 mg once daily or every other day) at least 10 days after beginning ritonavir.
 
Certain Statin Medications
Bosentan can decrease blood levels of certain statin medicines, potentially making the medication less effective. If you are taking a statin that could be affected by bosentan, your healthcare provider should check your cholesterol after starting bosentan. You may need a higher statin dosage to adequately control your cholesterol. 
 
Tacrolimus
In animal studies, combining tacrolimus and bosentan increased blood levels of bosentan. This possible interaction has not been studied in humans. However, to be safe, these medications should be used together with caution.
 
Warfarin
Bosentan may decrease blood levels of warfarin, potentially making the medicine less effective. Talk to your healthcare provider about this possible interaction if you will be taking these drugs together.
 

Bosentan Drug Information

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