Drug interactions
Bosentan + Tolvaptan
Severity: Moderate
Bosentan and Tolvaptan: moderate 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
Tolvaptan is a CYP3A4 substrate, and bosentan as a CYP3A4 inducer may reduce its concentrations. This could weaken its aquaretic effect and its effect on serum sodium.
What this interaction means in plain words
Bosentan and Tolvaptan can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Bosentan belongs to Miscellaneous; Tolvaptan belongs to Endocrine.
Why it happens
Bosentan induces CYP3A4, increasing tolvaptan metabolism.
What to do
Monitor serum sodium and clinical response, and adjust the tolvaptan dose as needed. Reassess if bosentan is started or stopped.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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
Other interactions of Tolvaptan
- Atazanavir + Tolvaptan Contraindicated
- Ceritinib + Tolvaptan Contraindicated
- Cobicistat + Tolvaptan Contraindicated
- Conivaptan + Tolvaptan Contraindicated
- Darunavir + Tolvaptan Contraindicated
- Idelalisib + Tolvaptan Contraindicated
Frequently asked questions
Can I take Bosentan with Tolvaptan?
MediHelp rates the interaction as moderate. Bosentan and Tolvaptan can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Tolvaptan is a CYP3A4 substrate, and bosentan as a CYP3A4 inducer may reduce its concentrations. This could weaken its aquaretic effect and its effect on serum sodium.
How serious is the interaction between Bosentan and Tolvaptan?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor serum sodium and clinical response, and adjust the tolvaptan dose as needed. Reassess if bosentan is started or stopped.
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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