Selexipag: Brands, Price & Uses in Bangladesh

Selexipag is indicated for the treatment of pulmonary arterial hypertension (PAH, WHO Group I) to delay disease progression and reduce the risk of hospitalization for PAH.

• Established/approved use: Long-term treatment of PAH to slow worsening of disease and lower the risk of PAH-related hospitalization.
• Combination therapy: Selexipag is commonly used as part of combination therapy with other PAH-specific medicines (e.g. endothelin receptor antagonists and/or phosphodiesterase-5 inhibitors), and clinical evidence for delaying disease progression is strongest when used in this combined approach; it may also be used as monotherapy in appropriate patients.
• Evidence base: Efficacy is supported by a large randomized controlled trial (event-driven, long-term outcome study) in patients with PAH, including idiopathic/heritable PAH and PAH associated with connective tissue disease.
• Selexipag is not approved for and should not be used in other forms of pulmonary hypertension (e.g. pulmonary hypertension due to left heart disease, lung disease, or chronic thromboembolic disease) outside of WHO Group I PAH.

Adult Dosing (Pulmonary Arterial Hypertension)

Administration

• Take by mouth, generally with food, to improve gastrointestinal tolerability.
• Swallow tablets whole; do not crush or split.
• If a dose is missed, take it as soon as possible unless the next scheduled dose is due, then resume the normal schedule — do not double the dose.
• If treatment is interrupted for several consecutive days or more, restart at the original starting dose (200 mcg twice daily) and re-titrate, rather than resuming the previously tolerated higher dose.

Dose Adjustment in Hepatic Impairment

• Mild impairment (Child-Pugh A): No dose adjustment required.
• Moderate impairment (Child-Pugh B): Start at 200 mcg once daily; titrate at weekly intervals as tolerated to a maximum of 800 mcg once daily.
• Severe impairment (Child-Pugh C): Contraindicated — see Contraindications.

Dose Adjustment with Strong CYP2C8 Inhibitors

When used with a strong CYP2C8 inhibitor (e.g. gemfibrozil), start at 200 mcg once daily and limit the maximum dose to 800 mcg once daily (see Interactions).

Renal Impairment

No dose adjustment is generally required for mild-to-moderate renal impairment. Data are limited in severe renal impairment or end-stage renal disease; use with caution.

Most adverse effects of Selexipag are related to its mechanism as a prostacyclin-pathway (IP receptor) agonist and are typically most pronounced during dose initiation and titration, generally lessening once a stable maintenance dose is reached.

Very Common / Common

• Headache
• Diarrhea, nausea, vomiting
• Jaw pain
• Myalgia (muscle pain), arthralgia, pain in extremities
• Flushing
• Reduced appetite

Less Common but Notable

• Hypotension (see Precautions and Warnings)
• Anemia / decreased red blood cell counts
• Rash
• Hyperthyroidism (reported uncommonly)

Patients should be counseled that gradual, protocol-based up-titration reduces the severity of these class-related effects; symptoms that are severe or persistent should be reported to the prescribing physician.