M Toronto Myositis Centreat St. Michael's Hospital
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Bosentan

Tracleer · say “boh-SEN-tan”
For preventing finger ulcers
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Monthly liver tests, and never in pregnancy.

Bosentan needs a blood test every month to check your liver. It must never be used in pregnancy, so reliable birth control and monthly pregnancy tests are required.

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What it is

Fewer new finger ulcers.

Bosentan blocks a natural body chemical (endothelin) that tightens blood vessels. It is approved to reduce the number of new finger ulcers in people with systemic sclerosis who keep getting them, and it is used the same way in myositis-overlap patients with repeated finger ulcers. It prevents new ulcers rather than healing ones you already have.

How to take it
  • A tablet twice a day. Usually 62.5 mg twice daily for the first month, then 125 mg twice daily.
  • Take it at the same times each day, and swallow it whole.
  • Do not stop on your own; tell your doctor if you want to stop.
What to expect
  • Fewer NEW finger ulcers over time.
  • It does not heal ulcers you already have; those need other care.
  • It is taken long-term while ulcers keep coming back.
Benefits

How it helps you.

Reduces new finger ulcers

Cuts down how many new ulcers you get.

A tablet

Taken by mouth.

An option when others fall short

Useful when blood-vessel-relaxing medicines are not enough.

Well studied

Good evidence in systemic sclerosis.

Risks & side effects

What you should know.

Your doctor chose this because the likely benefits outweigh the risks for you. Here is the honest, full picture.

Common side effects
Headache
Common, from widened blood vessels.
Flushing
A warm, red face.
Ankle swelling
Puffy ankles or legs.
Low red blood count (anemia)
Can make you tired or pale. It is checked on blood tests.
Serious but uncommon
Liver injury
It can affect the liver, so you have a blood test every month to catch this early.
Anemia
Your red blood count can drop, and is watched.
Fluid retention
Swelling in the legs; report a lot of swelling or breathlessness.
!
Liver tests every month, and never in pregnancy.

Bosentan can affect the liver, so you have a liver blood test every month. It causes serious birth defects, so you must not be pregnant. You need reliable birth control (hormonal birth control alone may not be enough) and a pregnancy test every month.

Staying safe

Monitoring and precautions.

Regular monitoring
  • Liver blood test every month.
  • Red blood count (hemoglobin) is checked regularly.
  • A pregnancy test every month for anyone who could become pregnant.
Everyday precautions
  • Use reliable birth control, usually a barrier method plus another method.
  • Tell your team every medicine you take, since bosentan interacts with many, including some birth control and cyclosporine.
  • Keep warm and do not smoke.
When to call your doctor

Contact the clinic if you notice:

Yellow skin or dark urine
With nausea or tiredness, this may mean the liver. Report promptly.
Unusual tiredness or paleness
May mean a low blood count. Report it.
A lot of swelling or breathlessness
Report marked leg swelling or trouble breathing.
A worsening finger ulcer
A sore that looks infected.

Pregnancy & breastfeeding

Bosentan must not be used in pregnancy, because it causes serious birth defects. Reliable birth control and a monthly pregnancy test are required while you take it. Tell your doctor at once if you might be pregnant.

!

This guide is for learning, not medical advice. Myositis care is different for everyone, and many of these medicines are used based on specialist experience rather than a formal Canadian myositis approval. Never start, stop, or change a medicine without your own doctor. Your doses are decided with your care team at the Centre.

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