What are the precautions for using Vericiguat tablets?

Vericiguat tablets (Vericiguat) is a soluble guanylate cyclase (sGC) stimulator. It is mainly used to treat patients with chronic heart failure with reduced ejection fraction (LVEF<45%) to reduce the risk of hospitalization or emergency treatment due to worsening of heart failure. Although vericiguat has shown good efficacy and safety in clinical trials, the following matters need to be paid attention to during use to ensure safe and effective treatment.

1. Risk of hypotension

The primary mechanism of action of vericiguat is to improve hemodynamics through vasodilation and therefore may lead to hypotension (particularly during treatment initiation or dose adjustment). Hypotension may cause dizziness, fatigue, and syncope. The risk may increase, especially when patients are taking other antihypertensive drugs (such as beta blockers, ACEI/ARB, ARNI, or diuretics) at the same time.

Things to note:

Blood pressure should be monitored regularly while taking the drug, especially during initiation or when adjusting the dose.

Avoid standing up suddenly to reduce the risk of orthostatic hypotension.

If symptoms of severe hypotension occur, you should contact your doctor to adjust the dose or discontinue the drug.

2. Risk of anemia

Clinical trials have shown that vericiguat may cause a drop in hemoglobin levels, leading to anemia. Anemia may present with symptoms such as fatigue, heart palpitations, dizziness, and pale complexion.

Things to note:

It is recommended to monitor hemoglobin levels regularly during medication.

If the symptoms of anemia are obvious or the hemoglobin continues to decrease, you need to consult your doctor whether to adjust the dose or take measures such as iron supplementation.

3. Drug use in patients with impaired renal function

Although vericiguat can be used in patients with mild to moderate renal impairment, data are limited and caution should be used in patients with severe renal impairment or those receiving dialysis.

Things to note:

Patients with mild to moderate renal impairment generally do not require dose adjustment, but renal function indicators should be monitored closely.

Patients with severe renal impairment or dialysis should use it with caution and decide whether the medication is suitable for them under the guidance of a doctor.

4. Drug use in patients with impaired liver function

维立西呱主要通过肝脏代谢，因此肝功能严重受损患者的药物清除可能会受到影响。

Things to note:

轻度至中度肝功能受损患者可以使用，但需监测肝功能。

Avoid use in patients with severe hepatic impairment (Child-Pugh C grade).

5. Drug Interactions

Vericiguat may interact with certain drugs, affecting efficacy or increasing the risk of adverse reactions.

避免联合使用：

Nitrates (such as nitroglycerin): combined use can cause severe hypotension and even shock.

磷酸二酯酶-5（PDE-5）抑制剂（如西地那非、他达拉非）：合用可能引起血压过度下降。

谨慎联合使用：

P-gp/BCRPStrong inhibitors (such as cyclosporine) may increase the plasma concentration of vericiguat and increase the risk of adverse reactions.

利尿剂 可增强降压作用，可能加重低血压症状，使用时需监测血压和电解质水平。

6. Medicine for pregnant and lactating women

Pregnant women: There is currently no sufficient clinical data, but animal experiments show that vericiguat may have adverse effects on the fetus, so it is contraindicated in pregnant women.

哺乳期：尚不清楚维立西呱是否会通过乳汁分泌，为安全起见，哺乳期妇女应避免使用，或在使用期间停止哺乳。

7. Drug use in elderly patients

In elderly patients 65 years old and above, the efficacy and safety of vericiguat are similar to those of younger patients. However, because the elderly are more sensitive to changes in blood pressure, the risk of hypotension needs to be monitored more intensively.

8. 服用方式和剂量调整

Vericiguat should be taken with food to increase drug absorption.

The recommended starting dose is 2.5 mg/day, and is gradually increased to the target dose of 10 mg/day every two weeks. Specific adjustments need to be based on patient tolerance.

If you miss a dose:

If you miss a dose It is less than12 hours, you should take it as soon as possible.

If you miss a dose more than12 hours, you should skip this dose and take it at the normal time next time. Do not take double doses.

9. Other possible adverse reactions

In addition to common adverse reactions such as hypotension, anemia, gastrointestinal discomfort (such as nausea, diarrhea), and dizziness, some patients may also experience symptoms such as musculoskeletal pain, rash, or palpitations. If symptoms are severe or persist, you should consult a doctor.

Vericiguat has good efficacy in the treatment of chronic heart failure, but during use it is necessary to pay attention to the safety of patients with hypotension, anemia, and impaired renal and liver function, and avoid combining it with nitrates, PDE-5 inhibitors and other drugs. Blood pressure, blood routine and renal function should be monitored regularly during medication to ensure safe and effective treatment. Patients should strictly follow the doctor's instructions, adjust the dosage reasonably, and avoid missing doses or overdosing, so as to minimize the risk of adverse reactions and improve the therapeutic effect.

Reference materials: https://www.gilead.com