Selexipag: Uses, Interactions and Safety
Uses
Selexipag is a selective prostacyclin IP-receptor agonist used for long-term pulmonary arterial hypertension (PAH) treatment. In the Turkish adult indication it can be added when an endothelin-receptor antagonist and/or PDE5 inhibitor is insufficient, or used alone when those treatments are unsuitable. It aims to delay disease progression and PAH-related complications.
Administration
This entry covers oral film-coated tablets. The specialist gradually adjusts treatment to the highest tolerated regimen. Taking it with food can improve tolerability. Tablets should be swallowed whole. After an interruption, ask the PAH team how to restart; returning immediately to the previous regimen may be inappropriate.
Safety
Low blood pressure can cause dizziness or fainting. Sudden worsening breathlessness or pulmonary oedema requires assessment for pulmonary veno-occlusive disease. The Turkish/European information also restricts use in certain serious cardiac conditions and recent heart attack or stroke. Severe liver impairment and dialysis require special consideration.
Interactions
Gemfibrozil is contraindicated because it greatly increases exposure to the active metabolite. Clopidogrel also increases exposure and requires a prescriber-managed reduction in the selexipag regimen. Rifampicin, carbamazepine and phenytoin may reduce active-metabolite exposure. Valproate, probenecid and fluconazole warrant caution because a potential metabolic interaction has not been excluded. These are not interchangeable with strong CYP3A interactions.
Pregnancy and breastfeeding
Use during pregnancy is not recommended, and effective contraception is needed. It should not be used while breastfeeding. Discuss pregnancy plans with the PAH team before making treatment changes.
Adverse effects
Headache, diarrhoea, jaw pain, nausea, vomiting, muscle or limb pain and flushing are frequent, especially during titration. Persistent intolerable effects need specialist review. US paediatric and intravenous authorisations differ from the Turkish tablet scope described here.
Sources
The linked Turkish profile contains the medicine record and its documented interaction list.