What is Macitentan and Tadalafil: Uses, Dosage, Side Effects and More

Macitentan and tadalafil is a combination medication that helps treat pulmonary arterial hypertension (PAH), a serious condition where blood pressure in your lungs becomes dangerously high. This dual-therapy approach combines two different medications that work together to open up your lung blood vessels and improve blood flow.

When you have PAH, the small arteries in your lungs become narrow and stiff, making your heart work much harder to pump blood through them. This combination medication tackles the problem from two angles, giving you a more comprehensive treatment approach than using either drug alone.

What is Macitentan and Tadalafil?

This medication combines two active ingredients that each target different pathways in your body to treat pulmonary arterial hypertension. Macitentan blocks certain receptors that cause blood vessels to narrow, while tadalafil helps relax the smooth muscle in your blood vessel walls.

The combination comes as oral tablets that you take by mouth, typically once daily. Your doctor prescribes this when single-drug therapy isn't providing enough benefit, or when your condition requires a more aggressive treatment approach from the start.

Both ingredients have been studied extensively on their own and together, showing that the combination can be more effective than either medication used alone for managing PAH symptoms and slowing disease progression.

What is Macitentan and Tadalafil Used For?

This combination medication is specifically designed to treat pulmonary arterial hypertension, a rare but serious condition affecting the arteries in your lungs. PAH makes it difficult for blood to flow through your lungs, putting strain on the right side of your heart.

Your doctor might prescribe this combination if you're experiencing symptoms like shortness of breath during daily activities, chest pain, fatigue, or swelling in your legs and ankles. These symptoms occur because your heart is working overtime to pump blood through narrowed lung arteries.

The medication helps improve your exercise capacity, meaning you can walk farther and do more activities without becoming as breathless. It also helps slow the progression of PAH, potentially reducing your risk of hospitalization and other serious complications.

How Does Macitentan and Tadalafil Work?

This combination medication works through two different mechanisms to provide comprehensive treatment for your pulmonary arterial hypertension. Think of it as addressing the problem from multiple angles to give you better results.

Macitentan blocks endothelin receptors in your blood vessels. Endothelin is a substance that causes blood vessels to tighten and narrow, so by blocking these receptors, macitentan helps keep your lung arteries more open and relaxed.

Tadalafil works by inhibiting an enzyme called PDE5, which leads to increased levels of a substance that helps blood vessels relax. This creates a smoother flow of blood through your lung arteries and reduces the pressure your heart faces.

Together, these medications create a synergistic effect, meaning they work better together than they would separately. This combination approach is considered moderately strong and is typically reserved for patients who need more comprehensive treatment.

How Should I Take Macitentan and Tadalafil?

Take this medication exactly as your doctor prescribes, typically once daily with or without food. You can take it with water, and it doesn't matter whether you eat before or after taking your dose.

Try to take your medication at the same time each day to maintain steady levels in your bloodstream. This helps ensure consistent treatment of your pulmonary arterial hypertension throughout the day.

Swallow the tablet whole without crushing, breaking, or chewing it. If you have trouble swallowing pills, talk to your doctor about alternative options or techniques that might help.

Don't stop taking this medication suddenly, even if you're feeling better. PAH is a chronic condition that requires ongoing treatment, and stopping abruptly could cause your symptoms to worsen quickly.

How Long Should I Take Macitentan and Tadalafil For?

This is typically a long-term treatment that you'll need to continue for as long as it's helping manage your pulmonary arterial hypertension effectively. PAH is a chronic condition that doesn't go away on its own, so ongoing medication is usually necessary.

Your doctor will monitor your response to treatment through regular check-ups, including tests to measure your exercise capacity and heart function. These appointments help determine whether the medication is working well for you and whether any adjustments are needed.

Some patients may need to take this combination for years, while others might eventually transition to different medications based on how their condition responds. Your treatment plan will be individualized based on your specific needs and how well you tolerate the medication.

What Are the Side Effects of Macitentan and Tadalafil?

Like all medications, this combination can cause side effects, though not everyone experiences them. Most side effects are manageable and tend to improve as your body adjusts to the medication.

Here are the more common side effects you might experience as your body adapts to this treatment:

• Headaches, which often improve after the first few weeks
• Flushing or feeling warm in your face and neck
• Swelling in your legs, ankles, or feet
• Nasal congestion or stuffy nose
• Upset stomach or nausea
• Dizziness, especially when standing up quickly
• Back pain or muscle aches

These common side effects usually become less bothersome over time, but let your doctor know if they persist or interfere with your daily activities.

Some serious side effects require immediate medical attention, though they're less common. Contact your doctor right away if you experience any of these concerning symptoms:

• Sudden vision changes or loss of vision
• Sudden hearing loss or ringing in your ears
• Chest pain or irregular heartbeat
• Severe dizziness or fainting
• Signs of liver problems like yellowing of skin or eyes
• Unusual shortness of breath or worsening breathing
• Painful erection lasting more than 4 hours (for men)

These serious side effects are rare, but it's important to recognize them early so you can get appropriate medical care if needed.

Who Should Not Take Macitentan and Tadalafil?

This combination medication isn't suitable for everyone, and your doctor will carefully review your medical history before prescribing it. Several conditions and medications can make this treatment unsafe or less effective.

You should not take this medication if you're currently using nitrate medications for chest pain, as this combination can cause a dangerous drop in blood pressure. This includes prescription nitrates like nitroglycerin and recreational drugs called "poppers."

Women who are pregnant or trying to become pregnant should avoid this medication, as it can cause serious birth defects. If you become pregnant while taking this medication, contact your doctor immediately to discuss safer alternatives.

People with severe liver disease or certain heart conditions may not be candidates for this treatment. Your doctor will assess your liver function and heart health before starting you on this medication.

If you have a history of vision problems, hearing loss, or low blood pressure, your doctor will need to weigh the benefits and risks carefully before prescribing this combination.

Macitentan and Tadalafil Brand Names

This combination medication is available under the brand name Opsynvi, which is the primary commercial formulation approved for treating pulmonary arterial hypertension. The brand name helps distinguish it from other medications containing these ingredients separately.

You might also encounter the individual components sold separately under different brand names. Macitentan is available as Opsumit, while tadalafil is known by several brand names including Cialis and Adcirca.

Always use the specific brand and formulation your doctor prescribes, as different formulations may have different strengths or release patterns that affect how well the medication works for your condition.

Macitentan and Tadalafil Alternatives

Several alternative treatments exist for pulmonary arterial hypertension if this combination isn't suitable for you or doesn't provide adequate symptom control. Your doctor can help determine which option might work best for your specific situation.

Other oral medications for PAH include bosentan, ambrisentan, sildenafil, and riociguat. Each of these works through different pathways to help open your lung blood vessels and reduce pulmonary pressure.

For more severe cases, your doctor might consider inhaled or intravenous medications like epoprostenol, treprostinil, or iloprost. These treatments are typically reserved for patients with more advanced disease or those who don't respond well to oral medications.

Some patients benefit from combination therapy using different classes of medications together, while others do well with sequential therapy where medications are added one at a time based on response.

Is Macitentan and Tadalafil Better Than Sildenafil?

Both medication approaches have their strengths, and the choice between them depends on your individual medical situation and treatment goals. Macitentan and tadalafil combination offers dual-pathway treatment, while sildenafil works through a single mechanism similar to tadalafil.

The combination approach may provide more comprehensive treatment because it addresses multiple pathways involved in PAH. Some studies suggest that dual therapy can be more effective than single-drug treatment for certain patients.

However, sildenafil has been used longer for PAH treatment and has extensive safety data. It might be preferred for patients who need a simpler treatment approach or who have specific medical conditions that make combination therapy less suitable.

Your doctor will consider factors like your disease severity, other medical conditions, current medications, and treatment goals when deciding which option is best for you.