Safety and tolerability of bosentan in adults with Eisenmenger physiology

Int J Cardiol. 2005 Jan;98(1):147-51. doi: 10.1016/j.ijcard.2004.08.025.


Background: Bosentan, a dual-endothelin receptor antagonist, is an established treatment for pulmonary arterial hypertension. We hypothesized that bosentan is safe and well tolerated in patients with Eisenmenger physiology.

Methods: In this pilot open-label study, we primarily examined safety and tolerability of oral bosentan. Patients were recruited from our adult congenital heart clinic following informed consent. Baseline and 3-month assessment included WHO functional class, resting oxygen saturations, 6-min walk test, transthoracic echocardiography and respiratory mass spectrometry. Patient clinical status and liver enzymes were closely monitored throughout.

Results: All 10 study patients (42+/-4 years; eight female) tolerated bosentan well. No major adverse events or significant liver enzyme elevations were observed. All but one patient felt better; none felt worse. Four patients experienced transient leg oedema. Resting oxygen saturations (83+/-5 versus 80+/-5%; P=0.011) and the distance travelled in the 6-min walk test (348+/-112 versus 249+/-117 m; P=0.004) increased relative to baseline. Changes in echocardiographic parameters (maximum aortic forward flow velocity 1.3+/-0.1 versus 1.1+/-0.2 ms, P=0.013; pulmonary arterial acceleration time 66+/-10 versus 58+/-12 m/s, P=0.02) and pulmonary blood flow (3.45+/-1.2 versus 2.58+/-1.0 L/min, P=0.008) suggested improved pulmonary haemodynamics by study end. Other echocardiographic changes suggested improved right ventricular systolic function (septal amplitude 1.0 versus 1.1 cm, P=0.048; systolic tissue Doppler velocity 4.8 versus 2.3 cm s(-1), P=0.002) by study end.

Conclusions: Bosentan was safe and well tolerated in adults with Eisenmenger physiology both at initiation and after 3 months of oral therapy. Clinical status of patients and pulmonary haemodynamics appeared to improve, and this warrants further investigation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use*
  • Blood Flow Velocity / drug effects
  • Blood Pressure / drug effects
  • Bosentan
  • Eisenmenger Complex / drug therapy*
  • Eisenmenger Complex / physiopathology*
  • Exercise Tolerance / drug effects
  • Female
  • Forced Expiratory Volume / drug effects
  • Heart Rate / drug effects
  • Humans
  • London
  • Male
  • Middle Aged
  • Oxygen Consumption / drug effects
  • Pilot Projects
  • Pulmonary Circulation / drug effects
  • Sulfonamides / adverse effects
  • Sulfonamides / therapeutic use*
  • Systole / drug effects
  • Treatment Outcome
  • Ventricular Function, Right / drug effects
  • Vital Capacity / drug effects


  • Antihypertensive Agents
  • Sulfonamides
  • Bosentan