Combination therapy with bosentan and phosphodiesterase-5 inhibitor in pulmonary arterial hypertension

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Abstract
Hoeper et al. 1 have produced an interesting report of their clinical experience of combined therapy with bosentan and sildenafil in patients with idiopathic pulmonary arterial hypertension. Whilst it is true that the relatively scant literature supporting the use of phosphodiesterase-5 inhibitors is centred around sildenafil, its relatively short duration of action requires the use of a thrice-daily regime. This has significant implications for compliance and, since treatment is continual, has large implications in the cost of treatment. It would be more logical to use a long-acting phosphodiesterase-5 inhibitor, and, with the advent of tadalafil, once-daily treatment becomes possible.

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