Clinical deterioration after sildenafil cessation in patients with pulmonary hypertension
Anne M Keogh, Andrew Jabbour, Christopher S Hayward, Peter S MacdonaldHeart Lung Transplant Unit, St Vincent’s Hospital, Sydney, New South Wales, AustraliaAbstract: Sildenafil is a selective inhibitor of phosphodiesterase type 5 (PDE-5). Its chronic administration has been shown to improve...
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doaj-13f2c8c1b8614da29d7b5c17b7119fb52020-11-25T01:26:11ZengDove Medical PressVascular Health and Risk Management1178-20482008-10-01Volume 4111111131694Clinical deterioration after sildenafil cessation in patients with pulmonary hypertensionAnne M KeoghAndrew JabbourChristopher S HaywardPeter S MacdonaldAnne M Keogh, Andrew Jabbour, Christopher S Hayward, Peter S MacdonaldHeart Lung Transplant Unit, St Vincent’s Hospital, Sydney, New South Wales, AustraliaAbstract: Sildenafil is a selective inhibitor of phosphodiesterase type 5 (PDE-5). Its chronic administration has been shown to improve exercise capacity, World Health Organization functional class, and haemodynamics in patients with symptomatic pulmonary arterial hypertension (PAH). There is however, no data describing the clinical consequences of sudden cessation of sildenafil treatment. In this series, 9 patients with NYHA Class II–IV PAH who were stable on 2 months of sildenafil monotherapy, had their sildenafil ceased to accommodate a 2-week washout period, required for enrollment in research involving an endothelin receptor antagonist. Six minute walk distance (SMWD) and clinical assessments were performed before cessation of sildenafil, and again 2 weeks later. Over the course of this 2-week washout period, 6 of the 9 patients reported increased breathlessness and fatigue, 1 of these was hospitalized with worsening right heart failure. The SMWD fell in 6 patients, with falls of greater than 100 m recorded in 4 patients. This was accompanied by a worsening of NYHA Class from 2.5 ± 0.2 to 3.1 ± 0.1 (mean ± SEM, p = 0.01). These data indicate that sudden cessation of sildenafil monotherapy, in patients with PAH, carries with it a significant and unpredictable risk of rapid clinical deterioration. We recommend that if sildenafil needs to be ceased, it would be more prudent to consider concurrent vasodilator therapy before the gradual cessation of sildenafil.Keywords: sildenafil, pulmonary hypertension, phosphodiesterase inhibitorhttps://www.dovepress.com/clinical-deterioration-after-sildenafil-cessation-in-patients-with-pul-peer-reviewed-article-VHRMSildenafilPulmonary HypertensionPhosphodiesterase inhibitor |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Anne M Keogh Andrew Jabbour Christopher S Hayward Peter S Macdonald |
spellingShingle |
Anne M Keogh Andrew Jabbour Christopher S Hayward Peter S Macdonald Clinical deterioration after sildenafil cessation in patients with pulmonary hypertension Vascular Health and Risk Management Sildenafil Pulmonary Hypertension Phosphodiesterase inhibitor |
author_facet |
Anne M Keogh Andrew Jabbour Christopher S Hayward Peter S Macdonald |
author_sort |
Anne M Keogh |
title |
Clinical deterioration after sildenafil cessation in patients with pulmonary hypertension |
title_short |
Clinical deterioration after sildenafil cessation in patients with pulmonary hypertension |
title_full |
Clinical deterioration after sildenafil cessation in patients with pulmonary hypertension |
title_fullStr |
Clinical deterioration after sildenafil cessation in patients with pulmonary hypertension |
title_full_unstemmed |
Clinical deterioration after sildenafil cessation in patients with pulmonary hypertension |
title_sort |
clinical deterioration after sildenafil cessation in patients with pulmonary hypertension |
publisher |
Dove Medical Press |
series |
Vascular Health and Risk Management |
issn |
1178-2048 |
publishDate |
2008-10-01 |
description |
Anne M Keogh, Andrew Jabbour, Christopher S Hayward, Peter S MacdonaldHeart Lung Transplant Unit, St Vincent’s Hospital, Sydney, New South Wales, AustraliaAbstract: Sildenafil is a selective inhibitor of phosphodiesterase type 5 (PDE-5). Its chronic administration has been shown to improve exercise capacity, World Health Organization functional class, and haemodynamics in patients with symptomatic pulmonary arterial hypertension (PAH). There is however, no data describing the clinical consequences of sudden cessation of sildenafil treatment. In this series, 9 patients with NYHA Class II–IV PAH who were stable on 2 months of sildenafil monotherapy, had their sildenafil ceased to accommodate a 2-week washout period, required for enrollment in research involving an endothelin receptor antagonist. Six minute walk distance (SMWD) and clinical assessments were performed before cessation of sildenafil, and again 2 weeks later. Over the course of this 2-week washout period, 6 of the 9 patients reported increased breathlessness and fatigue, 1 of these was hospitalized with worsening right heart failure. The SMWD fell in 6 patients, with falls of greater than 100 m recorded in 4 patients. This was accompanied by a worsening of NYHA Class from 2.5 ± 0.2 to 3.1 ± 0.1 (mean ± SEM, p = 0.01). These data indicate that sudden cessation of sildenafil monotherapy, in patients with PAH, carries with it a significant and unpredictable risk of rapid clinical deterioration. We recommend that if sildenafil needs to be ceased, it would be more prudent to consider concurrent vasodilator therapy before the gradual cessation of sildenafil.Keywords: sildenafil, pulmonary hypertension, phosphodiesterase inhibitor |
topic |
Sildenafil Pulmonary Hypertension Phosphodiesterase inhibitor |
url |
https://www.dovepress.com/clinical-deterioration-after-sildenafil-cessation-in-patients-with-pul-peer-reviewed-article-VHRM |
work_keys_str_mv |
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