Uptravi (selexipag) is a medicine used to treat pulmonary arterial hypertension (PAH). PAH is a serious condition where the blood pressure in the arteries supplying the lungs is abnormally high, causing increasing strain on the right side of the heart.

Selexipag belongs to a class called prostacyclin receptor agonists. It mimics the action of prostacyclin, a natural substance that relaxes and widens blood vessels in the lungs and prevents blood clots from forming. Unlike intravenous prostacyclins (such as Flolan), Uptravi is taken as an oral tablet twice daily.

Uptravi reduces the progression of PAH and decreases the risk of hospitalisation and disease worsening.

Treatment starts at the lowest dose (200 mcg twice daily) and is gradually increased by 200 mcg twice daily weekly until the highest individually tolerated dose is reached (up to 1600 mcg twice daily). This titration process is done under medical supervision.

Take each dose with food, at the same times each day (approximately every 12 hours). Food helps reduce side effects.

Swallow tablets whole. Do not crush, split, or chew them.

Do not stop taking Uptravi without speaking to your PAH specialist. PAH can worsen rapidly if treatment is stopped suddenly.

If you remember within 6 hours of the missed dose, take it with food as soon as possible. If more than 6 hours have passed, skip the dose and take the next one as usual. Never take two doses at once.

Seek urgent medical attention. Overdose may cause severe low blood pressure, nausea, vomiting, diarrhoea, and jaw pain.

• Store below 30°C
• Keep in the original packaging
• Keep out of reach of children

Side effects are common, especially during the dose titration period.

Very common side effects:

• Headache: the most common side effect
• Diarrhoea
• Nausea and vomiting
• Jaw pain (particularly when eating)
• Flushing
• Muscle, joint, or limb pain

Common side effects:

• Low blood pressure
• Anaemia
  

Most side effects are dose-related and occur more often during titration. They often lessen over time or can be managed with symptomatic treatment. Your PAH team will titrate the dose based on your tolerability.

• Strong CYP2C8 inhibitors (gemfibrozil): dramatically increase selexipag levels; avoid
• Strong CYP2C8 inducers (rifampicin, carbamazepine): reduce selexipag levels; avoid

Tell your PAH specialist and pharmacist about all medicines you take.

Why does the dose need to be increased slowly?

The gradual titration approach is designed to find the highest dose you can tolerate. Side effects such as headache, flushing, jaw pain, and nausea are common at higher doses. Increasing the dose slowly allows your body to adapt and lets your doctor identify your personal maximum tolerated dose. Taking more than you can tolerate causes unnecessary side effects without additional benefit. The process is done step by step over several weeks.

How is Uptravi different from Flolan (epoprostenol)?

Both medicines target the prostacyclin pathway in the lungs. Flolan (epoprostenol) is the active prostacyclin itself, given as a continuous IV infusion through a central line 24 hours a day. Uptravi (selexipag) is an oral tablet that acts on the same receptor. While Flolan is more potent and used in severe PAH, Uptravi offers the practical advantages of oral twice-daily dosing without the burden of a continuous pump and central line.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.