Drug interactions
Bosentan + Indinavir
Severity: Major
Bosentan and Indinavir: major interaction.
Last updated
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
Indinavir inhibits CYP3A4 and can substantially raise bosentan levels, increasing hepatotoxicity and hypotension risk. Bosentan may also lower indinavir concentrations, threatening virologic control.
What this interaction means in plain words
Bosentan and Indinavir 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.
Why it happens
Indinavir inhibits CYP3A4 metabolism of bosentan, while bosentan induces CYP3A4 and reduces protease inhibitor exposure.
What to do
If starting indinavir in a bosentan-treated patient, stop bosentan at least 36 hours before and restart after 10 days at 62.5 mg once daily or every other day. Monitor liver enzymes and HIV viral load.
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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Other interactions of Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan Major
Frequently asked questions
Can I take Bosentan with Indinavir?
MediHelp rates the interaction as major. Bosentan and Indinavir 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. Indinavir inhibits CYP3A4 and can substantially raise bosentan levels, increasing hepatotoxicity and hypotension risk. Bosentan may also lower indinavir concentrations, threatening virologic control.
How serious is the interaction between Bosentan and Indinavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: If starting indinavir in a bosentan-treated patient, stop bosentan at least 36 hours before and restart after 10 days at 62.5 mg once daily or every other day. Monitor liver enzymes and HIV viral load.
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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