Do I need to take macitentan (Aopuxil) for life? Doctor’s advice and risk analysis of drug discontinuation

Macitentan (macitentan) is an oral endothelin receptor antagonist, mainly used to treat pulmonary arterial hypertension (PAH). By blocking endothelin A and B receptors, it reduces pulmonary artery pressure and right heart load, thereby improving patients' exercise tolerance and quality of life. For most PAH patients, macitentan is a long-term maintenance treatment drug. Its goal is to continue to control the disease and delay the progression of the disease. Therefore, doctors usually recommend long-term or even lifelong use.

Whether lifelong use is required depends on the severity of the patient's condition and tolerance to the drug. For early-stage or mild patients, if the disease control is significantly improved through combination therapy, lifestyle intervention, and other drugs, doctors may evaluate whether the dose can be adjusted or try to discontinue the drug based on follow-up. However, generally speaking, due to the progressive and irreversible characteristics of PAH, arbitrary discontinuation of medication may lead to rapid deterioration of the condition, worsening of dyspnea, right heart failure, and even life-threatening consequences. Therefore, discontinuation of medication must be conducted under the guidance of a professional physician.

Risks of discontinuation mainly include rapid increase in pulmonary artery pressure, decreased exercise tolerance, increased right heart load, and increased risk of acute heart failure. In clinical practice, there have been reports of patients experiencing acute exacerbation of their condition due to voluntary discontinuation of medication, which reminds patients that they must strictly follow medical instructions. At the same time, doctors may adopt a strategy of gradually reducing the dose or replacing other drugs if necessary to reduce the risk of sudden drug withdrawal and ensure a safe transition for patients.

In daily management, patients need to regularly review cardiac ultrasound, blood oxygen saturation and NT-proBNP and other indicators, and communicate with doctors to adjust treatment plans based on changes in symptoms. In addition to drug treatment, reasonable exercise, low-salt diet and cardiopulmonary function monitoring are also important means to maintain the stability of the condition. Generally speaking, macitentan usually needs to be taken for a long time, but the specific plan needs to be formulated individually. The discontinuation of the drug needs to strictly assess the risks and be carried out under professional guidance to ensure safety and efficacy.

Keyword tag:

Macitentan, Aoposil, pulmonary arterial hypertension,PAH, lifelong use, risk of discontinuation, doctor's advice, long-term management, disease control

Reference materials:https://en.wikipedia.org/wiki/Macitentan