Nurses Compass
Drug Guide
Vericiguat
Classification
Therapeutic: Cardiovascular agent
Pharmacological: Soluble guanylate cyclase stimulator
FDA Approved Indications
- Chronic heart failure with reduced ejection fraction (HFrEF) to reduce the risk of cardiovascular death and heart failure hospitalization
Mechanism of Action
Vericiguat stimulates soluble guanylate cyclase (sGC), increasing cyclic guanosine monophosphate (cGMP) levels, which leads to vasodilation, reduced preload and afterload, and improved cardiac function.
Dosage and Administration
Adult: Initially 2.5 mg once daily, titrated based on tolerability and clinical response to a maximum of 10 mg once daily.
Pediatric: Not approved for pediatric use.
Geriatric: No special dosage adjustment; monitor renal and hepatic function.
Renal Impairment: Adjust dose based on renal function; specifics not established, use with caution.
Hepatic Impairment: Potential dose reduction recommended; specific guidelines not established.
Pharmacokinetics
Absorption: Rapidly absorbed with peak plasma concentrations in about 1-2 hours.
Distribution: Protein binding approximately 94%.
Metabolism: Primarily metabolized via non-CYP pathways; including glucuronidation and oxidation.
Excretion: Excreted mainly via feces (~66%) and urine (~27%).
Half Life: Approximately 20 hours, allowing for once-daily dosing.
Contraindications
- Hypersensitivity to vericiguat
- Use with soluble guanylate cyclase stimulators
Precautions
- Risk of hypotension, dizziness, anemia; monitor blood pressure and hemoglobin levels; cautious use in patients with low blood pressure or anemia.
Adverse Reactions - Common
- hypotension (>10%)
- anemia (<10%)
- dizziness (>10%)
- headache (>10%)
Adverse Reactions - Serious
- hypotension requiring intervention (Rare)
- syncope (Rare)
- hypersensitivity reactions (Rare)
Drug-Drug Interactions
- Nitrate medications (risk of severe hypotension)
- Other antihypertensives (potentiation)
Drug-Food Interactions
- No significant interactions reported
Drug-Herb Interactions
- No well-documented interactions
Nursing Implications
Assessment: Monitor blood pressure, heart rate, and symptoms of hypotension; assess for signs of anemia.
Diagnoses:
- Risk for hypotension
- Ineffective tissue perfusion
Implementation: Administer once daily, same time each day; monitor blood pressure regularly; educate patient on symptoms of hypotension.
Evaluation: Assess efficacy in reducing heart failure hospitalizations; monitor for adverse reactions and adverse drug reactions.
Patient/Family Teaching
- Take medication as prescribed, at the same time daily.
- Report symptoms of hypotension (dizziness, lightheadedness) or unexplained fatigue.
- Avoid concomitant use of nitrates or other blood pressure-lowering agents without consulting healthcare provider.
Special Considerations
Black Box Warnings:
- None issued for vericiguat at this time.
Genetic Factors: No specific genetic testing required.
Lab Test Interference: May cause anemia; monitor hemoglobin and hematocrit levels.
Overdose Management
Signs/Symptoms: Severe hypotension, dizziness, syncope.
Treatment: Supportive care; monitor vital signs; no specific antidote; consider activated charcoal if ingestion was recent; provide IV fluids as needed.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable under recommended storage conditions; protect from moisture and light.