Which group of medications must be used cautiously due to interactions when a patient is on bosentan?

Study for the Board Certified Cardiology Pharmacist Exam. Utilize flashcards and answer multiple-choice questions with detailed explanations. Prepare efficiently for your certification!

Bosentan is an endothelin receptor antagonist used primarily in the treatment of pulmonary arterial hypertension. It is known to influence the metabolism of other drugs because it is a potent inducer of cytochrome P450 enzymes, particularly CYP2C9 and CYP3A4. This enzyme induction can significantly affect the pharmacokinetics of medications that are metabolized by these pathways.

Anticoagulants, especially warfarin, are metabolized by the CYP2C9 enzyme. When bosentan is administered alongside these anticoagulants, the induction of CYP2C9 can lead to decreased anticoagulant effect, potentially increasing the risk for thromboembolic events due to inadequate anticoagulation. Additionally, selected direct oral anticoagulants that are substrates of CYP3A4 may also have altered effectiveness when bosentan is co-administered.

Understanding this interaction is crucial for managing patient safety, as the anticoagulant doses may need to be adjusted in patients receiving bosentan to maintain therapeutic efficacy and minimize the risk of adverse events.

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