Bosentan Side Effects

Medically reviewed by Drugs.com. Last updated on Jan 30, 2025.

Applies to bosentan: oral tablet, oral tablet for suspension.

Important warnings This medicine can cause some serious health issues

Oral route (tablet; tablet for suspension)

Because of the risks of hepatotoxicity and embryo-fetal toxicity, bosentan may be prescribed only through the Bosentan REMS Program.

Use of bosentan may result in hepatotoxicity or liver failure.

Measure serum aminotransferase levels prior to initiation of treatment and then monthly.

Stop treatment if liver aminotransferase elevations are accompanied by clinical symptoms of hepatotoxicity, or increases in bilirubin greater than or equal to 2 times ULN occur.

Use of bosentan is likely to produce major birth defects if used by pregnant women.

Exclude pregnancy before initiation of therapy and prevent pregnancy thereafter by the use of 2 forms of reliable contraception for the duration of treatment and for 1 month after stopping bosentan.

If the patient has an intrauterine device (IUD) or tubal sterilization, no other contraception is needed.

Monthly pregnancy tests should be obtained.

Serious side effects of bosentan

Along with its needed effects, bosentan may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking bosentan:

More common side effects

• blurred vision
• confusion
• dizziness
• dark urine
• faintness or lightheadedness when getting up from a lying or sitting position
• fever with or without chills
• light-colored stools
• loss of appetite
• nausea
• stomach pain
• sudden sweating
• unusual tiredness or weakness
• vomiting
• yellow eyes or skin

Less common side effects

• swelling

Incidence not known

• black, tarry stools
• bleeding gums
• blood in the urine or stools
• blue lips and fingernails
• chest pain
• chills
• clay-colored stools
• coughing that sometimes produces a pink frothy sputum
• coughing up blood
• dark urine
• decrease in the amount of urine
• difficult, fast, or noisy breathing
• fainting
• fast heartbeat
• fatigue on exertion
• fever
• headache
• hives, itching, skin rash
• hoarseness
• increased sweating
• irritation
• joint pain, stiffness, or swelling
• large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• noisy, rattling breathing
• pale skin
• pinpoint red spots on the skin
• redness of the skin
• shortness of breath
• swelling of the eyelids, face, lips, hands, fingers, legs, ankles, or feet
• tightness in the chest
• troubled breathing at rest or exertion
• troubled breathing or swallowing
• unpleasant breath odor
• unusual bleeding or bruising
• vomiting of blood
• weight gain

Get emergency help immediately if any of the following symptoms of overdose occur while taking bosentan:

Symptoms of overdose

• increased heart rate

Other side effects of bosentan

Some side effects of bosentan may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common side effects

• fast, irregular, pounding, or racing heartbeat or pulse
• feeling of warmth
• muscle aches
• redness of the face, neck, arms, and occasionally upper chest
• sore throat
• stuffy or runny nose

Less common side effects

• belching
• heartburn
• indigestion
• stomach discomfort, upset, or pain

For healthcare professionals

Applies to bosentan: oral tablet, oral tablet dispersible.

General adverse events

The most frequently reported side effects were headache, respiratory tract infection, anemia, decreased sperm count, and fluid retention/edema.^[Ref]

Hepatic

• Very common (10% or more): Liver function test abnormal (up to 10.9%)
• Common (1% to 10%): ALT increased, AST increased, hepatic enzyme increased
• Frequency not reported: Hepatotoxicity
• Postmarketing reports: Hepatic cirrhosis, liver failure, jaundice^[Ref]

Nervous system

• Very common (10% or more): Headache (up to 15%)
• Common (1% to 10%): Syncope^[Ref]

Respiratory

• Very common (10% or more): Respiratory tract infection (up to 22%)
• Common (1% to 10%): Sinusitis, nasal congestion, upper respiratory tract infection, lower respiratory tract infection, sinus congestion, rhinitis, oropharyngeal pain, epistaxis, nasopharyngitis, idiopathic pulmonary fibrosis^[Ref]

Hematologic

• Very common (10% or more): Hemoglobin decreased (up to 57%)
• Common (1% to 10%): Anemia, hematocrit decreased
• Postmarketing reports: Thrombocytopenia, transfusion, neutropenia, leukopenia^[Ref]

Cardiovascular

• Common (1% to 10%): Flushing, hypotension, palpitation, orthostatic hypotension, unstable angina, hot flush^[Ref]

Gastrointestinal

• Common (1% to 10%): Gastroesophageal reflux disease, diarrhea^[Ref]

Dermatologic

• Common (1% to 10%): Pruritus, erythema
• Postmarketing reports: Angioedema, drug reaction with eosinophilia and systemic symptoms (DRESS), rash, dermatitis^[Ref]

Genitourinary

• Very common (10% or more): Sperm count decreased (25%)^[Ref]

Musculoskeletal

• Common (1% to 10%): Arthralgia, joint swelling^[Ref]

Ocular

• Common (1% to 10%): Vision blurred^[Ref]

Other

• Very common (10% or more): Edema/fluid retention (up to 13.2%)
• Common (1% to 10%): Chest pain, peripheral edema, influenza-like illness, vertigo, pyrexia, chest pain^[Ref]

Immunologic

• Common (1% to 10%): Hypersensitivity reaction
• Postmarketing reports: Anaphylaxis^[Ref]

Further information

Bosentan side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer