Treatment of Pulmonary Arterial Hypertension with Sildenafil

Abstract

Purpose

The study aimed to evaluate data on the treatment of sildenafil for pulmonary arterial hypertension (PAH).

Selection Process

Clinical literature from 1966 to May 2003 was accessed through MEDLINE, EMBASE, IPA, and the Cochrane System. Key search terms included sildenafil, Viagra, and pulmonary hypertension.

Methods

Current treatment of PAH includes anticoagulation, vasodilation, and transplantation. Available oral agents include calcium channel blockers and endothelin receptor antagonists. An evaluation of studies of sildenafil for PAH was conducted.

Results

Sildenafil for PAH was reported to be effective in 21 of 23 patients summarized in 14 case reports; 6 short-term (n = 83) and four long-term (n = 68) clinical trials described sildenafil administered with standard treatments for PAH.

Conclusions

Sildenafil may be a convenient option for PAH after traditional treatments have been attempted. It is administered orally and is longer-acting than other treatments for PAH. A dose of 50 to 100 mg three times daily was used in adults in four long-term studies, although doses from 25 to 500 mg/day in two to six divided doses have also been used in case reports. The only long-term study in children gave a median dose of 87.5 mg/day in children greater than 5 years of age weighing less than 30 kg. Side effects in the clinical trials were minimal, consisting primarily of mild headache, dizziness, flushing, and mild abdominal discomfort. Further studies to define the exact role and the dosing range of sildenafil in the management of PAH are needed.