Drug interactions
Bosentan + Nelfinavir
Severity: Major
Bosentan and Nelfinavir: 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
Nelfinavir inhibits CYP3A4 and can markedly raise bosentan concentrations, raising the risk of hepatotoxicity, hypotension and edema. Bosentan, as a CYP3A4 inducer, may also lower nelfinavir levels, risking reduced antiviral effect.
What this interaction means in plain words
Bosentan and Nelfinavir 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; Nelfinavir belongs to Anti Virals.
Why it happens
Nelfinavir inhibits CYP3A4 (and transporter-mediated uptake) of bosentan, while bosentan induces CYP3A4 metabolism of nelfinavir.
What to do
In patients on bosentan, stop it at least 36 hours before starting the protease inhibitor and restart after about 10 days at a reduced dose (62.5 mg once daily or every other day). Monitor liver tests and viral 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 Nelfinavir
- Alfuzosin + Nelfinavir Contraindicated
- Avanafil + Nelfinavir Contraindicated
- Dronedarone + Nelfinavir Contraindicated
- Eletriptan + Nelfinavir Contraindicated
- Ergotamine + Nelfinavir Contraindicated
- Flibanserin + Nelfinavir Contraindicated
Frequently asked questions
Can I take Bosentan with Nelfinavir?
MediHelp rates the interaction as major. Bosentan and Nelfinavir 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. Nelfinavir inhibits CYP3A4 and can markedly raise bosentan concentrations, raising the risk of hepatotoxicity, hypotension and edema. Bosentan, as a CYP3A4 inducer, may also lower nelfinavir levels, risking reduced antiviral effect.
How serious is the interaction between Bosentan and Nelfinavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: In patients on bosentan, stop it at least 36 hours before starting the protease inhibitor and restart after about 10 days at a reduced dose (62.5 mg once daily or every other day). Monitor liver tests and viral 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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