Bosentan, sildenafil, and epoprostenol are targeted drugs for pulmonary arterial hypertension (PAH) that may improve respiratory function and help patients infected with SARS-CoV-2 survive the acute respiratory distress syndrome period of the infection, according to a review published in the journal Biomedicine & Pharmacotherapy

“A combination of these drugs should be considered due to synergism,” the authors said. However, they also warn that the use of these drugs should be very closely monitored as they can lead to a transient deterioration in the condition of the patient.

Acute respiratory distress syndrome is the most challenging complication of COVID-19. To identify a rescue treatment for patients who are rapidly deteriorating, a team of researchers led by Michał Wicinski, PhD, reviewed randomized controlled trials, reviews, and meta-analyses published until July 2020 to assess the potential of targeted PAH treatments in treating COVID-19.

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They found that studies reported endothelin receptor antagonists, phosphodiesterase 5 inhibitors, riociguat, and prostacyclin to have anti-inflammatory effects and to reduce pulmonary artery blood pressure, lung edema, and remodeling.

They also found that bosentan was reported to show antiviral properties. Sildenafil and epoprostenol were reported to inhibit apoptosis in the epithelial cells of the lungs.

“Among all assessed drugs bosentan, sildenafil and epoprostenol appear to be most promising,” the researchers wrote and added that treating COVID-19 associated acute respiratory distress syndrome with targeted PAH treatments could help save lives.

Bosentan is an endothelin receptor antagonist that promotes vasodilation and helps prevent pulmonary vascular constriction. Sildenafil is a phosphodiesterase type 5 enzyme inhibitor that has been shown to promote pulmonary vasodilation, improve exercise tolerance, and delay clinical worsening in PAH. Epoprostenol is a prostacyclin analog that relaxes the blood vessels in the lungs. All 3 drugs have been approved to treat patients with PAH.


Puk O, Nowacka A, Smulewicz K, et al. Pulmonary artery targeted therapy in treatment of COVID-19 related ARDS. Literature review. Biomed Pharmacother. Published online December 25, 2021. doi:10.1016/j.biopha.2021.112592