Bosentan and Dizziness: Clinical Evidence and Management

Evidence for Dizziness as a Side Effect

• Dizziness is documented as one of the frequently reported clinical adverse events with endothelin receptor antagonists including bosentan 1, 2

Pharmacological Basis

• Bosentan is a dual endothelin receptor antagonist (ERA) that blocks both endothelin A and B receptors 3

Frequency and Context

• In elderly patients, bosentan may cause more pronounced dizziness due to decreased baroreceptor response 4
• Patients with pre-existing cardiovascular conditions may experience more pronounced dizziness while taking bosentan 5

Management Considerations

• The European Society of Cardiology recommends evaluating for signs of hypoperfusion if dizziness occurs, and considering checking blood pressure to rule out significant hypotension 4

Other Important Side Effects to Monitor

• The American Thoracic Society and European Respiratory Society recommend monthly liver function tests to monitor for hepatotoxicity, a serious concern with bosentan 6, 5
• Regular hemoglobin/hematocrit checks are necessary to monitor for anemia 6
• Women of childbearing age should use careful contraception due to potential teratogenic effects of bosentan 6
• The European Heart Society notes that bosentan remains an important treatment option for pulmonary arterial hypertension, with substantial benefits in exercise capacity, hemodynamics, and functional class 5