Drug Action
Selexipag is a selective prostacyclin (IP) receptor agonist.
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Drug reference
Selexipag is a selective prostacyclin (IP) receptor agonist.
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Pulmonary arterial hypertension either as combination therapy (if insufficiently controlled with an endothelin receptor antagonist and/or a phosphodiesterase type-5 inhibitor), or as monotherapy (initiated under specialist supervision) ▶BY MOUTH ▶Adult: Initially 200 micrograms twice daily, increased in steps of 200 micrograms twice daily at weekly intervals up to the highest tolerated dose, usual maintenance 200–1600 micrograms twice daily, initial dose and first dose after each dose increase should be taken in the evening; maximum 3200 micrograms per day
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DUE TO INTERACTIONS ▶Manufacturer advises reduce dose frequency to once daily with concurrent use of clopidogrel or moderate CYP2C8 inhibitors.
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Cerebrovascular event (within the last 3 months). congenital or acquired valvular defects with myocardial function disorders (not related to pulmonary hypertension). decompensated cardiac failure (unless under close medical supervision). myocardial infarction (within last 6 months). severe arrhythmias. severe coronary heart disease. unstable angina
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Elderly (limited information available)
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Scottish Medicines Consortium (SMC) decisions SMC No. 1235/17 The Scottish Medicines Consortium has advised (updated May 2018) that selexipag (Uptravi ®) is accepted for restricted use within NHS Scotland for the long-term treatment of pulmonary arterial hypertension in adults with WHO functional class III, as combination therapy in patients insufficiently controlled with an endothelin receptor antagonist and a phosphodiesterase type-5 inhibitor, and who would be considered for treatment with inhaled iloprost. This advice is contingent upon the continuing availability of the patient access scheme in NHS Scotland or a list price that is equivalent or lower. All Wales Medicines Strategy Group (AWMSG) decisions AWMSG No. 700 The All Wales Medicines Strategy Group has advised (June 2018) that selexipag (Uptravi ®) is recommended as an option for restricted use within NHS Wales as a triple combination therapy for the treatment of pulmonary arterial hypertension (PAH) in adults with WHO functional class (FC) III who are insufficiently controlled on dual therapy with an endothelin receptor antagonist and a phosphodiesterase type-5 inhibitor. Selexipag (Uptravi ®) is not recommended for use within NHS Wales outside of this sub-population. This recommendation applies only in circumstances where the approved Wales Patient Access Scheme (WPAS) is utilised or where the list/contract price is equivalent or lower than the WPAS price.
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→Appendix 1: selexipag
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▶Common or very common Abdominal pain. anaemia. appetite decreased. arthralgia. diarrhoea. flushing. headache. hyperthyroidism. hypotension. myalgia. nasal congestion. nasopharyngitis. nausea. pain. skin reactions . vomiting. weight decreased ▶Uncommon Sinus tachycardia
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Manufacturer advises avoid—no information available.
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Manufacturer advises avoid—present in milk in animal studies.
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Manufacturer advises caution in moderate impairment (risk of increased exposure); avoid in severe impairment (no information available). Dose adjustments Manufacturer advises initial dose reduction to 200 micrograms once daily in moderate impairment, increased in steps of 200 micrograms once daily at weekly intervals up to the highest tolerated dose.
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Manufacturer advises caution with dose titration in severe impairment.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 21, 25 ▶Uptravi (Actelion Pharmaceuticals UK Ltd) A Selexipag 200 microgram Uptravi 200microgram tablets | 60 tablet P £3,000.00 | 140 tablet P £7,000.00 Selexipag 400 microgram Uptravi 400microgram tablets | 60 tablet P £3,000.00 Selexipag 600 microgram Uptravi 600microgram tablets | 60 tablet P £3,000.00 Selexipag 800 microgram Uptravi 800microgram tablets | 60 tablet P £3,000.00 Selexipag 1 mg Uptravi 1,000microgram tablets | 60 tablet P £3,000.00 Selexipag 1.2 mg Uptravi 1,200microgram tablets | 60 tablet P £3,000.00 Selexipag 1.4 mg Uptravi 1,400microgram tablets | 60 tablet P £3,000.00 Selexipag 1.6 mg Uptravi 1,600microgram tablets | 60 tablet P £3,000.00 ENDOTHELIN RECEPTOR ANTAGONISTS
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Missed doses Manufacturer advises if a dose is more than 6 hours late, the missed dose should not be taken and the next dose should be taken at the normal time; if a dose is missed for 3 days or more, treatment should be restarted at a lower dose and then increased—consult product literature.
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Initially 200 micrograms twice daily, increased
First-line fragment. Read the complete Indications and Dose section above.
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