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This medication comes with several important safety warnings and precautions that need to be considered before and during treatment. It is essential to consult your healthcare provider for any questions or concerns.

• Pregnancy Warning: This medication must not be used during pregnancy due to the risk of severe harm to an unborn baby. Women of childbearing potential should use reliable birth control methods before, during, and for one month after treatment. A pregnancy test is required before initiating treatment. If pregnancy occurs or is suspected, contact your healthcare provider immediately.

• Enrollment in REMS Program: For females who can become pregnant, this medication is only available through the Ambrisentan REMS program, which is designed to enhance safety by ensuring adherence to the recommended precautions.

• Fluid Retention: The medication may cause fluid retention in the body, potentially leading to swelling or shortness of breath. This is particularly concerning for individuals with a history of heart failure, as it can exacerbate the condition. Notify your healthcare provider if you experience symptoms such as shortness of breath, swelling in limbs, irregular heartbeat, inability to exercise, or fatigue.

• Anemia Risk: There is a potential for the medication to lower hemoglobin levels, which could lead to anemia. Monitoring of hemoglobin levels is advised during treatment, especially in the initial weeks, to prevent severe anemia.

• Contraindications: Do not use this medication if you are currently pregnant or if you have a lung condition called idiopathic pulmonary fibrosis (IPF).

In case of any emergency or signs of overdose, seek immediate medical attention. Always discuss any other medications or substances you are taking with your healthcare provider to avoid harmful interactions.

Common side effects:

• Stuffy or runny nose
• Flushing
• Swelling in the arms or legs
• Sinus infections
• Inflammation

Serious side effects:

• Fluid buildup in the body
• Difficulty breathing
• Swelling in the lower limbs
• Irregular heartbeat
• Chest pain
• Difficulty exercising
• Unusual tiredness
• Unexpected weight gain
• Signs of liver problems
• Persistent nausea or vomiting
• Loss of appetite
• Severe stomach pain
• Dark urine
• Yellowing of the skin or eyes
• Severe allergic reactions
• Rash
• Severe dizziness
• Difficulty breathing
• Swelling of the face, tongue, or throat

Ambrisentan is primarily processed in the liver through a pathway called glucuronidation, with minor involvement of enzymes known as CYP3A4 and CYP2C19. This means it generally has a lower risk of interacting with other medications compared to some other drugs. However, certain medications can still affect how ambrisentan works in your body.

For instance, Cyclosporine, a drug often used to suppress the immune system, can double the levels of ambrisentan in your blood. To prevent potential side effects, it's recommended to limit the ambrisentan dose to 5 mg once daily when taking it with cyclosporine.

On the other hand, studies have shown that ambrisentan does not significantly alter the effectiveness of Warfarin, a common blood thinner, or Sildenafil, a medication used for erectile dysfunction and pulmonary hypertension. This suggests that these drugs can generally be used together without adjusting their doses.

It's important to note that while ambrisentan has a relatively low potential for drug interactions, combining it with other medications that affect liver enzymes or drug transporters could still influence its effectiveness or increase the risk of side effects. Therefore, always inform your healthcare provider about all the medications, supplements, and herbal products you're currently using. This will help them manage your treatment plan effectively and safely.