Uptravi Dosage/Direction for Use

Treatment should only be initiated and monitored by a physician experienced in the treatment of PAH.
Selexipag can be used in combination therapy in patients insufficiently controlled with an endothelin receptor antagonist (ERA) and/or a phosphodiesterase type 5 (PDE 5) inhibitor, or as monotherapy in patients who are not candidates for these therapies.
Method of administration: The film-coated tablets are to be taken orally in the morning and in the evening. UPTRAVI should be taken consistently with or without food. Tolerability may be improved when taken with food.
The tablets should not be split, crushed or chewed, and are to be swallowed with some water.
Dosage: Individualised dose titration: The goal is to reach the individually appropriate dose for each patient (the individualised maintenance dose).
The recommended starting dose of UPTRAVI is 200 micrograms given twice daily, approximately 12 hours apart. The dose is increased in increments of 200 micrograms given twice daily, usually at weekly intervals, until adverse pharmacological effects that cannot be tolerated or medically managed are experienced, or until a maximum dose of 1600 micrograms twice daily is reached. At the beginning of treatment and at each up-titration step it is recommended to take the first dose in the evening. During dose titration, it is recommended not to discontinue treatment in the event of expected pharmacological side effects since they are usually transient or manageable with symptomatic treatment (see ADVERSE REACTIONS). If a patient reaches a dose that cannot be tolerated the dose should be reduced to the previous dose level.
Individualised maintenance dose: The highest tolerated dose reached during dose titration should be maintained. If the therapy is less tolerated at a given dose over time, symptomatic treatment or a dose reduction to the next lower dose should be considered. PAH patients have variable degrees of IP receptor expression.
Differences in maintenance dose of selexipag between individuals may be related to differences in IP receptor expression levels.
Interruptions and discontinuations: If a dose of medication is missed, it should be taken as soon as possible. The missed dose should not be taken if it is almost time for the next scheduled dose (within approximately 6 hours).
If treatment is missed for 3 days or more, UPTRAVI should be re-started at a lower dose and then titrated.
Dosage adjustment in elderly patients: Elderly (≥ 65 years): No adjustment to the dosing regimen is needed in elderly patients.
Dosage adjustment in patients with hepatic impairment: No adjustment to the dosing regimen is needed in patients with mild hepatic impairment (i.e., Child-Pugh class A). A once-daily regimen is recommended in patients with moderate hepatic impairment (Child-Pugh class B) due to increased exposure to selexipag and its active metabolite. Avoid use of UPTRAVI in patients with severe hepatic impairment (Child-Pugh class C, see CONTRAINDICATIONS).
Dosage adjustment in patients with renal impairment: No adjustment to the dosing regimen is needed in patients with mild or moderate renal impairment.
No change in starting dose is required in patients with severe renal impairment. Dose titration in these patients should be done with caution.
Dosage adjustment with co-administration of moderate CYP2C8 inhibitors: When co-administered with moderate CYP2C8 inhibitors (e.g., clopidogrel, deferasirox and teriflunomide), reduce the dosing of UPTRAVI to once daily. Revert to twice daily dosing frequency of UPTRAVI when co-administration of moderate CYP2C8 inhibitor is stopped. (see In-vivo studies Inhibitors of CYP2C8 under INTERACTIONS).