Uptravi vs Tyvaso

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Introduction

For patients with pulmonary arterial hypertension (PAH), certain drugs that alter the function of specific pathways in the body can help manage symptoms and slow disease progression. Uptravi and Tyvaso are two such drugs that are commonly prescribed for PAH. Each drug works on a different pathway, but both aim to relax and widen the blood vessels in your lungs, which lowers blood pressure within these vessels. Uptravi is an oral medication classified as a selective IP prostacyclin receptor agonist which helps to open up the pulmonary arteries making it easier for the heart to pump blood through them. On the other hand, Tyvaso is an inhaled therapy that acts directly on lung tissue by mimicking natural substances called prostaglandins; it's categorized as a synthetic analogue of prostacyclin, primarily affecting smooth muscle cells or fibroblasts.

What is Uptravi?

Selexipag (the generic name for Uptravi) is an oral tablet used to treat pulmonary arterial hypertension (PAH), a severe, progressive disease that can lead to heart failure. Approved by the FDA in 2015, Selexipag works primarily by relaxing and widening blood vessels in your lungs, reducing the pressure within these vessels and making it easier for your heart to pump blood through them. It has been shown to slow down the progression of PAH and decrease hospitalizations related to this condition.

On the other hand, Tyvaso (treprostinil) is an inhaled medication also approved for treating PAH. Instead of being taken orally like Uptravi, Tyvaso is nebulized into a mist which patients inhale directly into their lungs four times daily. This direct delivery method allows more of each dose to reach its target area with less systemic exposure thereby potentially minimizing side effects such as headache or nausea which are commonly associated with these types of medications.

In comparing both drugs, one must consider factors such as delivery method preference and potential side effects. Patients who have difficulty swallowing pills may prefer Tyvaso's inhalation method over Uptravi's pill form; however those who want fewer dosing instances may opt for Uptravi since it only needs be taken once or twice daily compared to four times per day with Tyvaso.

What conditions is Uptravi approved to treat?

Uptravi and Tyvaso are both approved for the treatment of different forms of pulmonary hypertension:

Uptravi is used in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) after surgery or if surgery is not suitable
Tyvaso, on the other hand, is indicated for use in patients with pulmonary arterial hypertension (PAH), to improve exercise ability

How does Uptravi help with these illnesses?

Uptravi helps to manage Pulmonary Arterial Hypertension (PAH) by increasing the levels of prostacyclin, a potent vasodilator — a substance that widens the blood vessels. It achieves this by stimulating the prostacyclin receptor. Prostacyclin is an important mediator in vascular health, playing crucial roles in inhibiting platelet aggregation and protecting endothelial cells.

In individuals with PAH, there is an imbalance between vasoconstrictors and vasodilators - specifically lower levels of prostacyclin. Therefore, by enhancing the action of prostacyclin through its receptor stimulation, Uptravi can limit negative effects associated with PAH such as breathlessness and fatigue. This helps patients better manage their condition and improve their quality of life.

On the other hand, Tyvaso is another medication used for managing PAH but it works slightly differently from Uptravi. Tyvaso also enhances prostacyclin activity but it does so directly since it's an aerosol form of synthetic prostacyclin. The primary advantage here is targeted delivery to lungs minimizing systemic side effects.

What is Tyvaso?

Tyvaso, a brand name for treprostinil, is a synthetic analog of prostacyclin. It works by helping to open blood vessels in the lungs, reducing the workload on your heart and improving exercise ability and symptoms in patients with pulmonary arterial hypertension (PAH). Treprostinil was first approved as an injectable medication by the FDA in 2002.

Unlike Uptravi which comes as tablets taken orally twice daily, Tyvaso is delivered directly into the lungs through inhalation using a nebulizer four times daily. This direct delivery can mean fewer systemic side effects compared to oral medications. Like other vasodilators used for PAH treatment, common side effects include headache, flushing, nausea and diarrhea. However specific to Tyvaso due its method of administration includes coughing or throat irritation immediately following use.

The targeted effect on pulmonary arteries makes it particularly beneficial for PAH patients who may not respond well enough to oral treatments like Uptravi alone.

What conditions is Tyvaso approved to treat?

Tyvaso has been FDA-approved to manage:

Pulmonary arterial hypertension (PAH, a high blood pressure condition affecting the arteries in the lungs and the right side of your heart)
Pulmonary hypertension associated with interstitial lung disease (PH-ILD, a type of pulmonary hypertension that often occurs as a result of diseases causing scarring or inflammation in the lungs)

How does Tyvaso help with these illnesses?

Tyvaso is a medication that, like Uptravi, plays an important role in the management of pulmonary arterial hypertension (PAH). Tyvaso works by directly relaxing and dilating the pulmonary arteries via acting as a selective agonist for prostacyclin receptors. This reduction in vascular resistance helps to decrease blood pressure within these vessels and improve oxygen delivery to tissues, alleviating some of the symptoms associated with PAH such as shortness of breath and fatigue. Unlike Uptravi which is taken orally, Tyvaso is administered through inhalation allowing it to act directly on lung tissue which may result in fewer systemic side effects. It can be prescribed when a patient does not respond well or cannot tolerate oral medications for PAH, or it may be combined with other drugs used to manage this condition.

How effective are both Uptravi and Tyvaso?

Both selexipag (Uptravi) and treprostinil (Tyvaso) are FDA approved for the treatment of pulmonary arterial hypertension (PAH). These drugs were launched at different times, with Uptravi receiving approval in 2015 and Tyvaso earlier in 2009. Despite the difference in their launch dates, both have shown promising results in managing symptoms related to PAH.

Selexipag is a selective IP prostacyclin receptor agonist that helps relax and widen blood vessels, thus improving blood flow. Meanwhile, Tyvaso is an analogue of prostacyclin designed to dilate systemic and pulmonary arterial vascular beds. Clinical trials involving these two medications demonstrate comparable efficacy levels in reducing disease progression and hospitalization from PAH; however, their administration modes differ significantly —selexipag is taken orally while treprostinil requires inhalation through a nebulizer.

A systematic review conducted in 2020 showed that patients taking selexipag had better exercise capacity compared to placebo-treated groups after 26 weeks of therapy. The same study also highlighted its safety profile being similar to other antihypertensive medications used for PAH treatment.

On the other hand, clinical data support that nebulized form of treprostinil improves exercise capacity within twelve weeks into starting therapy without any major adverse effects. However, it's worth noting that unlike oral medication like selexipag which can be taken anywhere at anytime conveniently by swallowing tablets with water , the need for regular inhalations could pose as a challenge when considering patient compliance with tyvaso prescription. Despite these differences between Uptravi and Tyvaso , both medications remain critical options available for healthcare providers treating individuals suffering from PAH depending on individual patient preferences , health conditions or possible drug interactions .

abstract image of a researcher studying a bottle of drug.

At what dose is Uptravi typically prescribed?

Oral dosages of Uptravi typically start at 200 mcg twice daily, and are increased by 200 mcg increments every week based on tolerability to a maximum dose of 1600 mcg twice daily. For Tyvaso, the initial recommended dosage is three breaths (18 micrograms) four times daily during waking hours, approximately four hours apart. The dosage can be increased in weekly increments without exceeding nine breaths (54 micrograms) per treatment session to reach an optimal response. It's important not to surpass the prescribed dosage in either case without consulting with your healthcare provider.

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At what dose is Tyvaso typically prescribed?

Tyvaso treatment for pulmonary arterial hypertension usually begins with a dose of 3 breaths (18 mcg) per treatment session, four times daily. This dose can then be increased weekly to the target dosage of 9 breaths (54 mcg) per session, divided into four sessions spaced approximately 4 hours apart throughout waking hours. The maximum recommended total daily dose is 36 breaths (216 mcg). These adjustments may be made based on patient response and tolerability. Remember that it's important to adhere to scheduled doses and not exceed your prescribed daily limit. If there is no improvement in symptoms after several weeks at the target dosage, consult with your doctor about potential next steps in your treatment plan.

What are the most common side effects for Uptravi?

Common side effects of Uptravi can include:

Headaches
Diarrhea
Jaw pain
Nausea
Vomiting
Muscle Pain
Joint pain
Decreased appetite
Rash

On the other hand, Tyvaso may cause:

Cough or throat irritation
Headache
Dizziness or faintness (especially upon standing)
Flushing and skin redness
Nasal congestion, sinusitis, runny nose
Nausea, diarrhea, vomiting.

It is important to note that while these are common side effects of each medication individually, not every person will experience them. Always consult with your healthcare provider for information tailored to your specific situation.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Uptravi?

When comparing Uptravi to Tyvaso, it is important to be aware of potential side effects. For example:

Severe allergic reactions: These can include hives, difficulty breathing or swallowing, swelling in your face or throat.
Bleeding problems: If you notice unusual bruising or bleeding from the nose and gums.
Persistent coughing or wheezing
Chest pain; shortness of breath
Edema (swelling) especially in the lower limbs
Rapid weight gain due to fluid retention
Symptoms related to low blood pressure such as dizziness, fainting spells, blurry vision

In addition:

If you experience symptoms like severe nausea, vomiting and diarrhea which could indicate a condition called Pulmonary veno occlusive disease (PVOD), seek medical attention immediately.

Also rare but serious adverse events reported are hyperthyroidism and liver issues. Signs for these may include unexplained weight loss/gain, heat intolerance,cold hands/feet,fatigue,yellow skin / eyes , dark urine and abdominal pain.

Seek immediate emergency help if you experience any of the above symptoms while taking either Uptravi or Tyvaso.

What are the most common side effects for Tyvaso?

Tyvaso, an inhaled medication for pulmonary arterial hypertension (PAH), can potentially cause a number of side effects that patients should be aware of. They might experience coughing, sore throat or mouth irritation due to the method of administration. Some patients have reported experiencing headaches and dizziness. Gastrointestinal issues such as nausea and diarrhea have also been noted with Tyvaso use. Other possible side effects include chest pain or discomfort, palpitations indicative of a fast heartbeat, and potential weight loss over time due to reduced appetite. In rare cases, some individuals may develop skin rash after using Tyvaso.

Are there any potential serious side effects for Tyvaso?

Tyvaso, while generally safe and effective for treating pulmonary arterial hypertension, can potentially cause serious side effects in rare cases. These may include:

Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
Bloody cough or spitting up blood
Rapid weight loss due to decreased appetite
Worsening shortness of breath (this could be a sign that the medication is not working effectively)
Symptoms indicating high levels of serotonin in the body like hallucinations, fever, fast heart rate, overactive reflexes and nausea/vomiting/diarrhea.

It's important to immediately seek medical attention if you notice any above symptoms after taking Tyvaso.

Contraindications for Uptravi and Tyvaso?

Both Uptravi and Tyvaso, along with many other drugs used to treat pulmonary arterial hypertension (PAH), may exacerbate symptoms in some individuals. If you notice an aggravation of your condition or a significant increase in difficulty breathing, please seek immediate medical attention.

Neither Uptravi nor Tyvaso should be taken if you are currently taking, or have recently stopped taking, medications that strongly inhibit or induce CYP2C8 enzymes. Always inform your physician about any medications you are currently on; these types of drugs will require a period to clear from the system to prevent adverse interactions with both Uptravi and Tyvaso. Furthermore, caution is advised for patients who are prone to low blood pressure as these medications can cause further decreases in blood pressure levels.

How much do Uptravi and Tyvaso cost?

For the brand name versions of these drugs:

The price of a 30-day supply of Uptravi (1.25 mg twice daily) is about $13,500, which works out to approximately $450/day depending on your dose.
The price for a month's supply of Tyvaso with an average dosage (18 breaths four times per day) averages around $11,000, working out to roughly $366/day.

Thus, if you are taking higher dosages or more frequent administrations of Uptravi (2.5 mg twice daily), then brand-name Tyvaso may be less expensive on a per-day treatment basis. However, cost should not be the primary consideration in determining which drug is right for you as both medications are specially used under specific clinical conditions and their usage should be determined by your healthcare provider.

There are currently no generic equivalents available for either Uptravi or Tyvaso resulting in high costs associated with these treatments:

Selexipag is the active ingredient in Uptravi and although it comes in tablet form similar to many other drugs there is no cheaper alternative at present time.
Similarly, treprostinil - the active ingredient found in Tyvaso – despite being available as different brands used through various routes (oral/inhaled/infused), all tend to have significantly high prices without any significant difference among them.

Popularity of Uptravi and Tyvaso

Selexipag, commonly known as Uptravi, is a medication used for the treatment of pulmonary arterial hypertension (PAH) and was prescribed to nearly 9,000 patients in the US in 2020. This accounts for about 15% of prescriptions given to PAH patients. Selexipag has been on an upward trend since its approval by the FDA in late 2015 due to its oral administration and positive impact on reducing hospitalization rates among PAH patients.

On the other hand, treprostinil inhalation solution, marketed under brand names like Tyvaso, was prescribed to around 7,500 people with pulmonary arterial hypertension in the USA during that same year. In terms of overall prescription numbers within this patient group, it accounted for approximately 13%. The prevalence of Tyvaso has remained relatively steady over recent years even though it requires nebulized administration four times daily which can be inconvenient compared to selexipag's twice-daily oral dosing.

Conclusion

Both Uptravi (selexipag) and Tyvaso (treprostinil) are potent medications used to treat pulmonary arterial hypertension, a condition characterized by high blood pressure in the arteries of the lungs. They have been proven effective through numerous clinical studies and meta-analyses, showing they improve exercise capacity and delay disease progression compared to placebo treatments.

The drugs work differently: Uptravi is an oral medication that works by relaxing the muscles in your heart and blood vessels, whereas Tyvaso is an inhalation solution that helps widen blood vessels in the lungs, reducing pressure on your heart.

Uptravi may be considered as first-line therapy for PAH due to its convenient oral administration, while Tyvaso might be used for patients who cannot tolerate oral medication or need a more immediate effect since it gets delivered directly into the lungs via inhalation.

Both drugs are available only under brand names which means they can be quite expensive especially for those paying out-of-pocket. Both Uptravi and Tyvaso require careful dosage adjustment at initiation of treatment based on each patient's tolerance level.

In terms of side effects, both drugs share common symptoms like headache, diarrhea or nausea but with differences; Uptravi could lead to jaw pain or joint discomfort while coughing or throat irritation might occur with Tyvaso use. Patients must monitor their symptoms closely when initiating these therapies and seek medical help promptly if side effects worsen.