vericiguat

REMS

To reduce the risk of cardiovascular death and HF hospitalization following a hospitalization for HF or need for outpatient IV diuretics, in patients with symptomatic, chronic HF and ejection fraction <45%.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Concurrent use of other soluble guanylate cyclase stimulators;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

eGFR <15 mL/min/1.73 m² at treatment initiation or on dialysis;
Severe hepatic impairment;
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension

Hemat: anemia

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with soluble guanylate cyclase stimulators, including riociguat, is contraindicated.
PDE-5 inhibitors, including avanafil, sildenafil, tadalafil, or vardenafil, may ↑ risk of hypotension; concurrent use not recommended.

Availability ⬆ ⬇

Tablets: 2.5 mg; 5 mg; 10 mg

Route/Dosage ⬆ ⬇

PO (Adults ): 2.5 mg once daily. Double the dose every 2 wk, as tolerated, until target dose of 10 mg once daily is achieved.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Stimulates soluble guanylate cyclase, a cardiopulmonary enzyme and receptor for nitric oxide, which, when stimulated, produces cyclic guanine monophosphate (cGMP), an important regulator of vascular tone, cardiac contractility, and cardiac remodeling. HF is associated with impaired synthesis of nitric oxide and ↓ activity of soluble guanylate cylase. Increasing nitric oxide and cGMP levels leads to vasodilation.

Therapeutic effects:

Reduction in risk of cardiovascular death and HF hospitalization.

Classifications ⬆ ⬇

Therapeutic Classification: heart failure agents

Pharmacologic Classification: soluble guanylate cyclase stimulators (sGS)

Pharmacokinetics ⬆ ⬇

Absorption: 93% absorbed following oral administration. ↑ absorption with food.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Primarily undergoes glucuronidation by UGT1A9 and to a lesser extent by UGT1A1 to form an inactive N-glucuronide metabolite. Primarily excreted in urine (53%) as inactive metabolite, with 45% excreted in feces as unchanged drug.

Half-Life: 30 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1 hr (fasting); 4 hr (with food)	24 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
- Advise patient to take a missed dose as soon as remembered on the same day. Do not take two doses of vericiguat on the same day.
Advise patient to notify health care professional if symptoms of hypotension (dizziness, fatigue) occur. Advise patient to change positions slowly; when recumbent, sit first; then stand slowly with something to hold onto. Drink plenty of water unless advised otherwise and avoid very hot baths or showers.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Rep: May cause fetal harm. Advise women of reproductive potential to use effective contraception during and for 1 mo after therapy and to avoid breastfeeding. Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Health care professionals should report prenatal vericiguat exposure to the Pregnancy Surveillance Program: 1-877-888-4231; https://pregnancyreporting.verquvo-us.com.

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Indications ⬇