I’m planning to start Sildenafil in secondary PAH due to different lung pathology. I'm really looking to find out at what dose of Sildenafil will be the most effective in stabilisation of PAH.
What experimental model you will use? The literature recommends 20mg three times daily in patients with PAH.
Thank you Dr Ivonne....I have started with 12.5 mg thrice daily, monitoring PASP by Echocardiography.
Nitric oxide activates soluble guanylate cyclase to increase cyclic GMP, which is hydrolyzed to 5'GMP by PDE5. Elevation of cGMP in smooth muscle causes relaxation, which the inhibition of PDE5 prolongs and accentuates. In the pulmonary bed, inhibition of PDE5 induces vasodilation.
Dear Colleague,
PAH due to lung disease is not PAH. So, there is currently no evidence for PAH specific drug therapy for these patient but even class III recommandation. However, a tailored approach (i.e. a patient with severe PH and mild COPD or ILD) could be discussed for each particular case. Alternatively, participation to clinical trial is probable the only convenient way to proceed.
Kind regards.
FL
I would also add that echo is an appropriate tool to monitor PH patients but one should always remember that:
- Pressure evolution means nothing (it could be either due to an improvement or a worsening of PH) without cardiac output. Echo evaluation should be centered on parameters with prognostic value (i.e. TAPSE, pericardial effusion, etc.), wich is not the case for sPAP.
- RHC is the only gold standard to assess PVR
-Accuracy of echo for sPAP was around 60% in a recent meta-analysis (Taled M. et al, Echocardiography 2013).
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