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Phosphodiesterase-5 inhibitors in management of pulmonary hypertension: safety, tolerability, and efficacy.

Buckley MS, Staib RL, Wicks LM, Feldman JP - Drug Healthc Patient Saf (2010)

Bottom Line: Agent selection depends upon several factors including efficacy, side effect profile, and cost, as well as convenience of administration.Overall, these medications were effective and well tolerated with a relatively benign side effect profile.Further studies are needed to determine the optimal doses of this therapeutic drug class, as well as its effects as adjunctive therapy with other agents in PAH.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmacy, Banner Good Samaritan Medical Center, and.

ABSTRACT
Pulmonary arterial hypertension (PAH) is a progressive disease that causes severe disability and has no cure. Over the past 20 years, a variety of treatment options have evolved for the management of PAH. With an expanded therapeutic armamentarium come more complex decisions regarding treatment options. Agent selection depends upon several factors including efficacy, side effect profile, and cost, as well as convenience of administration. We have undertaken a review of phosphodiesterase-5 (PDE-5) inhibitors in PAH with a focus on efficacy and safety. A literature search was conducted using the Medline and Cochrane Central Register of Controlled Trials databases (1966-February 2010) for relevant randomized clinical studies. Overall, 10 studies met our inclusion criteria. Sildenafil was the most commonly studied agent, followed by tadalafil and vardenafil. Most trials found that the PDE-5 inhibitors significantly improved exercise capacity and lowered pulmonary pressures. However, there were conflicting results regarding these agents' impact on improving cardiac function and functional class. Overall, these medications were effective and well tolerated with a relatively benign side effect profile. The PDE-5 inhibitors are an important option in treating PAH. While most of the published clinical data involved sildenafil, the other PDE-5 inhibitors show promise as well. Further studies are needed to determine the optimal doses of this therapeutic drug class, as well as its effects as adjunctive therapy with other agents in PAH.

No MeSH data available.


Related in: MedlinePlus

Updated clinical classification system on the 2008 World Symposium.6Abbreviations: ALK1, activin receptor-like kinase type 1; BMPR2, bone morphogenetic protein receptor type 2; HIV, human immunodeficiency virus.
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f1-dhps-2-151: Updated clinical classification system on the 2008 World Symposium.6Abbreviations: ALK1, activin receptor-like kinase type 1; BMPR2, bone morphogenetic protein receptor type 2; HIV, human immunodeficiency virus.

Mentions: The most widely accepted definition of PAH is a mean pulmonary arterial pressure (MPAP) ≥25 mmHg at rest, normal left-sided filling pressures (pulmonary capillary wedge pressure <15 mmHg), and elevated pulmonary vascular resistance (>3 Wood units).3,4 A classification system has evolved and undergone several revisions.5 The most recently updated Dana Point clinical classification from the Fourth World Symposium on Pulmonary Hypertension is illustrated in Figure 1.6


Phosphodiesterase-5 inhibitors in management of pulmonary hypertension: safety, tolerability, and efficacy.

Buckley MS, Staib RL, Wicks LM, Feldman JP - Drug Healthc Patient Saf (2010)

Updated clinical classification system on the 2008 World Symposium.6Abbreviations: ALK1, activin receptor-like kinase type 1; BMPR2, bone morphogenetic protein receptor type 2; HIV, human immunodeficiency virus.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3108715&req=5

f1-dhps-2-151: Updated clinical classification system on the 2008 World Symposium.6Abbreviations: ALK1, activin receptor-like kinase type 1; BMPR2, bone morphogenetic protein receptor type 2; HIV, human immunodeficiency virus.
Mentions: The most widely accepted definition of PAH is a mean pulmonary arterial pressure (MPAP) ≥25 mmHg at rest, normal left-sided filling pressures (pulmonary capillary wedge pressure <15 mmHg), and elevated pulmonary vascular resistance (>3 Wood units).3,4 A classification system has evolved and undergone several revisions.5 The most recently updated Dana Point clinical classification from the Fourth World Symposium on Pulmonary Hypertension is illustrated in Figure 1.6

Bottom Line: Agent selection depends upon several factors including efficacy, side effect profile, and cost, as well as convenience of administration.Overall, these medications were effective and well tolerated with a relatively benign side effect profile.Further studies are needed to determine the optimal doses of this therapeutic drug class, as well as its effects as adjunctive therapy with other agents in PAH.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmacy, Banner Good Samaritan Medical Center, and.

ABSTRACT
Pulmonary arterial hypertension (PAH) is a progressive disease that causes severe disability and has no cure. Over the past 20 years, a variety of treatment options have evolved for the management of PAH. With an expanded therapeutic armamentarium come more complex decisions regarding treatment options. Agent selection depends upon several factors including efficacy, side effect profile, and cost, as well as convenience of administration. We have undertaken a review of phosphodiesterase-5 (PDE-5) inhibitors in PAH with a focus on efficacy and safety. A literature search was conducted using the Medline and Cochrane Central Register of Controlled Trials databases (1966-February 2010) for relevant randomized clinical studies. Overall, 10 studies met our inclusion criteria. Sildenafil was the most commonly studied agent, followed by tadalafil and vardenafil. Most trials found that the PDE-5 inhibitors significantly improved exercise capacity and lowered pulmonary pressures. However, there were conflicting results regarding these agents' impact on improving cardiac function and functional class. Overall, these medications were effective and well tolerated with a relatively benign side effect profile. The PDE-5 inhibitors are an important option in treating PAH. While most of the published clinical data involved sildenafil, the other PDE-5 inhibitors show promise as well. Further studies are needed to determine the optimal doses of this therapeutic drug class, as well as its effects as adjunctive therapy with other agents in PAH.

No MeSH data available.


Related in: MedlinePlus