Fundacio Lluita contra la SIDA, Barcelona, Spain.
Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet, s/n, 08916 Badalona, Barcelona, Spain.
BMC Nephrol. 2020 Jan 28;21(1):24. doi: 10.1186/s12882-019-1659-5.
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).
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%.
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.
安立生坦是一种选择性内皮素受体拮抗剂，用于治疗肺动脉高压（PAH）。对于终末期肾病（ESRD）患者的血液透析清除安立生坦的情况知之甚少。
一名 53 岁女性，HIV/丙型肝炎病毒（HCV）合并感染，患有 PAH 和 ESRD，正在接受常规血液透析，因在使用波生坦（125mg，每日两次）和他达拉非（20mg，每日一次）治疗 PAH 和抗逆转录病毒治疗（cART）期间出现难治性心力衰竭而住院，cART 包括达芦那韦/考比司他（800/150mg，每日一次）。由于波生坦和达芦那韦/考比司他之间的药物相互作用，怀疑其对波生坦的暴露过高。用安立生坦替代了波生坦，其临床状况逐渐改善。测定了患者血液透析前和透析器后的安立生坦血浆浓度，并计算出安立生坦的血液透析提取率为 2%。
我们的结果表明血液透析对安立生坦的清除作用很小，因此在接受血液透析的 ESRD 患者中，似乎不需要对安立生坦进行特殊的剂量调整。
