Related Experiment Video
Updated: Jul 7, 2026

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease
Published on: August 24, 2019
Sildenafil for pulmonary hypertension: dose-dependent improvement in exercise performance
Riina Marjaana Spring1, Silvia Ulrich, Lars C Huber
1Department of Internal Medicine, University Hospital, Raemistrasse 100, CH-8091 Zurich, Switzerland.
Sildenafil at 50mg three times daily significantly improved 6-minute walking distance (6-MWD) in patients. Lower doses of 12.5mg and 25mg showed no significant changes in 6-MWD, indicating a dose-response relationship.
Area of Science:
- Cardiology
- Pulmonology
- Pharmacology
Background:
- Sildenafil is an established orphan drug, commonly prescribed at 50mg three times daily (tid).
- Recent studies suggest no dose-response relationship, proposing a future target dose of 20mg tid.
- A potential reduction in efficacy for patients on 50mg tid is a concern.
Purpose of the Study:
- To investigate the dose-response relationship of sildenafil in patients previously titrated to 50mg tid.
- To evaluate the effect of sildenafil on 6-minute walking distance (6-MWD) at different dosage levels.
Main Methods:
- A retrospective analysis of 23 patients with measured 6-MWD at sildenafil doses of 12.5mg, 25mg, and 50mg tid.
- Comparison of 6-MWD measurements at baseline and after dose escalation.
Main Results:
- 6-MWD remained unchanged at sildenafil doses of 12.5mg and 25mg tid.
- A significant improvement in 6-MWD was observed at 50mg tid compared to both baseline (34+/-63m, p=0.015) and 25mg tid (26+/-47m, p=0.014).
Conclusions:
- Sildenafil demonstrates a clinically relevant dose-response relationship.
- Significant improvements in 6-MWD are achieved specifically at the 50mg tid dosage.
Related Concept Videos
Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue, improving...
Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
Pulmonary Hypertension: Classification and Pathogenesis
There are various classifications for PH, each relating to different underlying causes and also...
Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme (ECE). Of...
