AZOLES AND BOSENTAN
Ketoconazole increases bosentan levels 2-fold, but the clinical significance of this is unclear. Fluconazole and voriconazole are predicted to have a greater effect.
As elevated bosentan levels are associated with an increased risk of liver toxicity the manufacturers do not recommend the concurrent use of azoles (particularly fluconazole). If the combination is used it may be prudent to monitor liver function closely. The manufacturers suggest that no dosage adjustment is likely to be required if ketoconazole were to be used with bosentan.
As elevated bosentan levels are associated with an increased risk of liver toxicity the manufacturers do not recommend the concurrent use of azoles (particularly fluconazole). If the combination is used it may be prudent to monitor liver function closely. The manufacturers suggest that no dosage adjustment is likely to be required if ketoconazole were to be used with bosentan.