What is the recommended dosage for bosentan in liver impairment?

Bosentan dosing with regard to liver impairment:

- Mild hepatic impairment (Child-Pugh A): no dose adjustment is usually needed. Start with 62.5 mg twice daily for 4 weeks, then if liver tests remain normal and well tolerated, increase to 125 mg twice daily.

- Moderate to severe hepatic impairment (Child-Pugh B or C): bosentan is contraindicated; it should not be used.

- In all cases, baseline liver function tests are required and monthly monitoring is recommended (especially during the first year). If transaminases rise significantly or bilirubin elevations occur, discontinue or appropriately manage therapy.

If you have a specific patient scenario (Child-Pugh class, other meds, etc.), I can tailor the guidance.