vericiguat: clinical use

Prescribing considerations

• Confirm stabilisation after the recent decompensation event and optimise volume status and diuretic therapy before initiation.
• Assess resting blood pressure and risks for symptomatic hypotension, including hypovolaemia, autonomic dysfunction, outflow obstruction and concurrent vasodilators.
• Use is not recommended in severe hepatic impairment, advanced renal impairment below the studied threshold, or dialysis.
• Safety and efficacy have not been established in people under 18 years.
• Check pregnancy potential and contraception where relevant.

Contraindications and cautions

• Hypersensitivity to vericiguat or an excipient.
• Concurrent use of another soluble guanylate cyclase stimulator, such as riociguat.

Monitoring

• Blood pressure and symptoms such as dizziness, light-headedness or fainting.
• Volume status and clinical stability following decompensated heart failure.
• Renal and hepatic function to identify populations in whom treatment is not recommended.
• Clinical features of anaemia and other reported adverse effects.
• Suspected adverse reactions, with reporting through the Yellow Card scheme where appropriate.

Clinical pharmacology

Vericiguat directly stimulates soluble guanylate cyclase and acts synergistically with nitric oxide to increase intracellular cyclic GMP. It is highly protein-bound and is cleared mainly through UGT1A9- and UGT1A1-mediated glucuronidation, with CYP metabolism contributing minimally.

Formulation and product differences

• The selected product is a film-coated tablet containing lactose and is essentially sodium-free.
• The tablet may be crushed and mixed with water immediately before administration.

Tablet

Route: Oral

Strengths: 2.5 mg, 5 mg, 10 mg