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Many different medications are available to treat pulmonary hypertension (PH). These treatments — all approved by the U.S. Food and Drug and Administration (FDA) — can be effective in reducing symptoms of the condition. They work as vasodilators, meaning they open (or dilate) blood vessels. However, they can also cause side effects, such as gastrointestinal (GI) issues, pain in certain parts of the body, swelling, bleeding, low blood pressure, and others. These side effects vary from person to person and the type of medication.
If you or a loved one are living with PH, speak with your health care provider about the types of medications available and any concerns you may have about potential side effects. If you do start to experience side effects while using a medication, contact your health care provider immediately.
Prostacyclin is a compound naturally produced in the body that makes blood vessels widen to increase blood flow. Prostacyclin analogs are commonly prescribed to treat pulmonary arterial hypertension. Commonly used prostacyclin analogs include epoprostenol (sold as Flolan and Veletri) and treprostinil (sold as Orenitram, Remodulin, and Tyvaso).
Prostacyclin analogs are potent drugs that can cause a number of side effects. Generalized side effects of treatment include nausea, vomiting, and headaches. Other common side effects can include:
Soluble guanylate cyclase (sGC) stimulators widen blood vessels by stimulating activity of a protein called guanylate cyclase. The sGC stimulators may be used to treat chronic thromboembolic pulmonary hypertension, a type of PH where blood clots block the arteries in the lungs for long periods of time. A commonly prescribed sGC stimulator is riociguat (Adempas).
Treatment with sGC stimulators can cause side effects consistent with symptoms of low blood pressure, including nausea, headache, dizziness, and lightheadedness.
Gastrointestinal issues may also occur as a result of treatment. GI-related side effects include upset stomach and gastroesophageal reflux disease (GERD).
People undergoing treatment may also experience:
Endothelin receptor antagonists (ERAs) reduce the function of endothelins, molecules that cause constriction of the blood vessels. Drugs that fall into this class include:
As with many other PH medications, ERAs can result in low blood pressure and can cause side effects such as nausea and dizziness. Other common side effects include:
GI problems such as constipation, diarrhea, and GERD are also common.
ERAs can lead to serious side effects including pulmonary edema (an accumulation of fluid in the lungs) and reproductive defects. Special consideration for pregnant women should be taken before prescribing ERAs.
Phosphodiesterase type 5 (PDE5) is an enzyme that, similar to endothelins, plays a role in constricting blood vessels. These drugs help to dilate blood vessels and reduce blood pressure. This class of drugs includes tadalafil (Adcirca) and sildenafil (Revatio).
PDE5 inhibitors commonly cause headaches, low blood pressure, and flushing of the skin caused by dilated blood vessels. Other side effects include:
In rare cases, PDE5 inhibitors have been associated with severe side effects including sudden loss of vision or hearing. PDE5 inhibitors are also used to treat erectile dysfunction and can cause prolonged, painful erections that require medical attention.
Anticoagulants reduce the coagulation (clumping) of blood cells, thereby thinning the blood and reducing the risk of blood clots. The most common anticoagulant drug used in the treatment of pulmonary hypertension is warfarin (Coumadin).
Due to its function as a blood thinner, the primary side effect associated with anticoagulant treatment is excessive bleeding. This can manifest in several ways, including:
In the event of an injury or bodily trauma, a person taking an anticoagulant runs the risk of bleeding becoming uncontrollable. Such a case would require immediate medical attention.
Also called water pills, diuretics are often prescribed to treat high blood pressure. This class of drugs works by eliminating sodium and water through urination, thereby lowering blood pressure. Common diuretics include:
Due to their mechanism of action, diuretics generally cause an increase in urination. Additional side effects can include dehydration, headaches, low sodium, and muscle cramps.
Diuretics also can affect potassium levels, causing them to become too high or too low, depending on the exact drug given. On rare occasions, a very low potassium level can result in a life-threatening condition.
Calcium channel blockers dilate the arteries and decrease the force with which the heart pumps. This can relieve high blood pressure and other conditions such as chest pain. Types of calcium channel blockers include:
Common side effects of this treatment include:
Grapefruit juice can exacerbate some of these side effects and should be avoided while taking calcium channel blockers.
MyPHTeam is the social network for people with pulmonary hypertension and their loved ones. On myPHteam, more than 46,000 members come together to ask questions, give advice, and share their stories with others who understand life with PH.
Are you or a loved one living with side effects of pulmonary hypertension medications? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Steven C. Pugliese, M.D. is affiliated with the Hospital of the University of Pennsylvania in Philadelphia, serving as the director of the pulmonary embolism response team, co-director of the comprehensive pulmonary embolism program, and an assistant professor of clinical medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Aminah Wali, Ph.D. received her doctorate in genetics and molecular biology from the University of North Carolina at Chapel Hill. Learn more about her here.
