Vericiguat is indicated to reduce the risk of cardiovascular death and heart failure (HF) hospitalization following a hospitalization for heart failure or the need for outpatient IV diuretics, in adults with symptomatic chronic HF and ejection fraction less than 45%.

Vericiguat is a stimulator of soluble guanylate cyclase (sGC), a key enzyme in the nitric oxide (NO) signaling pathway. When NO binds to sGC, it catalyzes the formation of cyclic guanosine monophosphate (cGMP), an important second messenger that regulates vascular tone, cardiac contractility, and cardiac remodeling. In heart failure, NO production and sGC activity are reduced, contributing to impaired myocardial and vascular function. Vericiguat directly stimulates sGC, both independently of and synergistically with NO, leading to increased intracellular cGMP levels. This results in smooth muscle relaxation and vasodilation.

Recommended Starting Dose: The recommended starting dose of Vericiguat is 2.5 mg orally once daily with food.
Double the dose of Vericiguat approximately every 2 weeks to reach the target maintenance dose of 10 mg once daily, as tolerated by the patient. For patients who are unable to swallow whole tablet, Vericiguat may be crushed and mixed with water immediately before administration or as directed by physician.

Geriatric Patients: No dosage adjustment of Vericiguat is required in geriatric patients. No overall differences in safety or efficacy of Vericiguat were observed between patients aged 65 years and older compared to younger patients, but greater sensitivity of some older individuals cannot be ruled out.

Hepatic Impairment: No dosage adjustment of Vericiguat is recommended in patients with mild or moderate hepatic impairment.

Renal Impairment: No dosage adjustment of Vericiguat is recommended in patients with estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73m² who are not on dialysis. Vericiguat has not been studied in patients with eGFR <15 mL/min/1.73m² at treatment initiation or on dialysis.

Use in Children & Adolescents: Safety and effectiveness of Vericiguat have not been established in pediatric patients.”

Other Soluble Guanylate Cyclase Stimulators: Vericiguat is contraindicated in patients receiving concomitant therapy with other soluble guanylate cyclase (sGC) stimulators.

PDE-5 Inhibitors: Concomitant use of Vericiguat with PDE-5 inhibitors is not recommended due to the potential risk of hypotension.

With food & others: Vericiguat should be taken with food. Its absolute bioavailability is about 93% when taken with food.

Vericiguat is contraindicated in patients using other soluble guanylate cyclase (sGC) stimulators.

Common side effects: Low blood pressure (hypotension) and anemia (low red blood cells).

Pregnancy: Vericiguat is contraindicated in pregnancy as it may cause fetal harm. Pregnancy should be excluded before starting treatment. Females of reproductive potential must use effective contraception during treatment and for one month after stopping therapy.

Nursing Mothers: There are no sufficient data on the presence of Vericiguat in human milk or its effects on the breastfed infant. Due to potential risk of serious adverse effects, breastfeeding is not recommended during treatment.

Vericiguat should not be used during pregnancy due to the risk of fetal harm. A pregnancy test should be performed in females of reproductive potential before starting treatment. Pregnancy must be excluded prior to initiation. Effective contraception is required during treatment and for one month after discontinuation.

Limited data are available in human overdose cases. Doses up to 10 mg have been studied, and up to 15 mg was generally well tolerated in certain studies. Overdose may lead to hypotension. Symptomatic treatment is recommended. Vericiguat is unlikely to be removed by hemodialysis due to high protein binding.

Stimulator of soluble guanylate cyclase

Keep below 30°C, protected from light and moisture. Keep out of reach of children.