Drug interactions
Bosentan + Darunavir
Severity: Major
Bosentan and Darunavir: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Ritonavir- or cobicistat-boosted darunavir inhibits CYP3A4 and raises bosentan exposure considerably, while bosentan may modestly lower darunavir concentrations. The main risk is bosentan toxicity including hepatotoxicity and hypotension.
What this interaction means in plain words
Bosentan and Darunavir can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Bosentan belongs to Miscellaneous; Darunavir belongs to Anti Virals.
Why it happens
Boosted darunavir inhibits CYP3A4 and OATP-mediated bosentan clearance; bosentan induces CYP3A4 and may lower protease inhibitor levels.
What to do
Stop bosentan at least 36 hours before starting the boosted protease inhibitor and restart after about 10 days at 62.5 mg once daily or every other day. Monitor liver enzymes and virologic response.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan Major
Other interactions of Darunavir
- Alfuzosin + Darunavir Contraindicated
- Avanafil + Darunavir Contraindicated
- Darunavir + Dronedarone Contraindicated
- Darunavir + Eletriptan Contraindicated
- Darunavir + Ergotamine Contraindicated
- Darunavir + Flibanserin Contraindicated
Frequently asked questions
Can I take Bosentan with Darunavir?
MediHelp rates the interaction as major. Bosentan and Darunavir can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Ritonavir- or cobicistat-boosted darunavir inhibits CYP3A4 and raises bosentan exposure considerably, while bosentan may modestly lower darunavir concentrations. The main risk is bosentan toxicity including hepatotoxicity and hypotension.
How serious is the interaction between Bosentan and Darunavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Stop bosentan at least 36 hours before starting the boosted protease inhibitor and restart after about 10 days at 62.5 mg once daily or every other day. Monitor liver enzymes and virologic response.
What other medicines interact with Bosentan?
MediHelp also lists interactions of Bosentan with, for example, Cyclosporin, Glibenclamide, Glyburide-metformin. The full list is on the Bosentan page.
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