Uptravi (Selexipag) Tapering Protocol
Uptravi should be tapered gradually by reducing the dose by approximately 200 μg twice daily every 2 weeks until the lowest dose is reached, then further extending the dosing interval before discontinuation.
Recommended Tapering Approach
- Slow tapering is recommended to minimize adverse effects and withdrawal symptoms, with dose reductions of approximately 200 μg twice daily every 2 weeks 1
- For patients on stable therapy, tapering should only be considered after achieving a stable response for at least 6 months 1
- Continue tapering until reaching the lowest available dose (200 μg twice daily), then switch to an extended interval dosing schedule before complete discontinuation 1
Extended Interval Dosing Schedule
- After reaching the 200 μg twice daily dose, transition to:
Monitoring During Tapering
- Monitor for signs of disease progression or clinical deterioration at each dose reduction step 2, 3
- If clinical deterioration occurs during tapering, return to the previous well-tolerated dose 1
- Unstable response during tapering indicates the need to maintain therapy at the lowest effective dose rather than proceeding with discontinuation 1
Special Considerations
- Patients who have been on Uptravi for longer periods (years) may require even more gradual tapering schedules 1
- Patients transitioning from Uptravi to another prostacyclin pathway medication should have overlap therapy to prevent clinical deterioration 3
- For pediatric patients, dose reductions should be calculated based on weight (μg/kg) rather than absolute dose 3
Potential Withdrawal/Rebound Effects
- Abrupt discontinuation may lead to worsening pulmonary arterial hypertension symptoms 2, 4
- Signs of clinical deterioration include increased dyspnea, decreased exercise capacity, and worsening hemodynamics 3, 4
- If withdrawal symptoms occur, re-introduce the previous well-tolerated dose and consider a slower tapering schedule 1