Bosentan (Tracleer®)

Self administration - Oral

Indications for Prior Authorization

  • indicated for the treatment of pulmonary hypertension to improve exercise ability.

Patients must meet the following criteria for the indication(s) above.

Diagnosis of primary pulmonary hypertension class II, III, or IV symptoms confirmed by a cardiologist/pulmonologist/rheumatologist.

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee.

  • peripheral vasoconstriction
  • patients on tadalafil or sildenafil therapy
  • All non-FDA approved uses not listed in the approved indications

Recommended Dosing

Patient < 40 Kg

  • Tracleer: 62.5 mg twice a day
  • Maximum dose: 125 mg per day

Patient > 40 Kg

  • Tracleer: Start at 62.5 mg twice a day for 4 weeks, then 125 mg twice a day
  • Maximum dose: 250 mg per day; adjust dose for impair liver function


One year

Western Health Advantage Pharmacy and Therapeutics Committee

Approved/Revised: March 2011 Reviewed: December 2013