What is Vericiguat?

Vericiguat is an oral medication used as an adjunct to standard therapy in adults with symptomatic chronic heart failure with reduced ejection fraction (HFrEF) who remain at high risk of cardiovascular death or heart failure hospitalization. It is designed to improve cardiac performance by enhancing the nitric oxide–sGC–cGMP pathway.

Reference: U.S. Food and Drug Administration (FDA) vericiguat prescribing information; ClinicalTrials.gov (VICTORIA trial, NCT02861534)

What are the other popular names for Vericiguat?

Vericiguat is marketed under the brand name Verquvo. In clinical practice and academic literature, it is also referred to by its generic name, vericiguat.

Reference: U.S. FDA; ClinicalTrials.gov

What is the drug classification of Vericiguat?

Vericiguat is classified as an oral soluble guanylate cyclase (sGC) stimulator. It falls under the therapeutic category of heart failure medications, specifically indicated for patients with HFrEF.

Reference: U.S. FDA; National Institutes of Health (NIH); American Heart Association (AHA) guidelines

What is the mode of action of Vericiguat?

Vericiguat works by enhancing the sensitivity of soluble guanylate cyclase (sGC) to endogenous nitric oxide (NO) and by directly stimulating sGC. This dual mechanism increases the production of cyclic guanosine monophosphate (cGMP), leading to:

• Vasodilation: Relaxation of vascular smooth muscle reduces afterload.
• Improved Cardiac Efficiency: Lower resistance allows the heart to pump more effectively without significantly increasing oxygen demand.
• Reduced Cardiac Remodeling: Over time, these effects may help limit adverse structural changes in the heart.

Reference: New England Journal of Medicine (NEJM) – VICTORIA trial (NEJMoa1917589); U.S. FDA

How is Vericiguat used?

Vericiguat is used as an adjunct to guideline‑directed medical therapy (GDMT) in patients with symptomatic chronic HFrEF. It is prescribed for patients who continue to experience symptoms despite treatment with beta‑blockers, ACE inhibitors or ARBs, and mineralocorticoid receptor antagonists.

Reference: American Heart Association (AHA) guidelines; ClinicalTrials.gov (VICTORIA trial)

What is the recommended dosage and administration for Vericiguat?

• Dosage:
  • Treatment typically begins with a lower dose (for example, 2.5 mg once daily) with gradual up-titration to a target maintenance dose (commonly between 10 mg and 15 mg once daily) based on clinical response and tolerability.
• Administration:
  • Vericiguat is taken orally in capsule form. It may be taken with or without food, but consistent dosing at the same time each day is advised for maintaining steady plasma levels.

Reference: U.S. FDA vericiguat prescribing information; ClinicalTrials.gov (VICTORIA trial, NCT02861534)

What prescribing information is important for Vericiguat?

• Indications:
  • Vericiguat is indicated to reduce the risk of cardiovascular death and heart failure hospitalization in patients with chronic HFrEF who are at high risk despite optimal medical therapy.
• Contraindications:
  • It is contraindicated in patients with a known hypersensitivity to vericiguat or any component of the formulation.
  • Concomitant use with nitrates or potent phosphodiesterase type 5 (PDE5) inhibitors is contraindicated due to the risk of severe hypotension.
• Monitoring:
  • Patients should be regularly monitored for blood pressure, renal function, and serum electrolytes.
• Special Considerations:
  • Vericiguat is not recommended during pregnancy. Women of childbearing potential must use effective contraception during treatment and for a period after discontinuation.

Reference: U.S. Food and Drug Administration (FDA) vericiguat label; National Institutes of Health (NIH) clinical guidelines

What safety information, warnings, and cautions are associated with Vericiguat?

• Common Side Effects:
  • Hypotension, dizziness, headache, and anemia.
• Warnings & Cautions:
  • Hypotension: Patients are at risk for low blood pressure, especially during dose titration. Advise slow position changes and monitor blood pressure closely.
  • Fetal Harm: Vericiguat is contraindicated in pregnancy.
  • Drug Interactions:
    • Concomitant use with nitrates or PDE5 inhibitors may lead to severe hypotension.
    • Coadministration with other antihypertensives may result in additive blood pressure–lowering effects.
  • Organ Function: Caution is advised in patients with impaired renal or hepatic function; these patients require dose adjustments and close monitoring.

Reference: U.S. FDA; New England Journal of Medicine (NEJM) – VICTORIA trial; American Heart Association (AHA) guidelines

What drug interactions should be considered with Vericiguat?

• Nitrates and PDE5 Inhibitors (e.g., Sildenafil, Tadalafil):
  • These are contraindicated when used with vericiguat because of the risk of profound hypotension.
• Other Antihypertensive Agents:
  • Concurrent use may enhance blood pressure–lowering effects and necessitate dosage adjustments.
• Agents Affecting Renal Function:
  • Drugs that impair renal hemodynamics may affect the pharmacokinetics of vericiguat; close monitoring is advised.

Reference: U.S. FDA vericiguat label; Clinical Pharmacology Reviews on PubMed

Where can I find additional clinical evidence and detailed information about Vericiguat?

For further details on clinical studies, dosing guidelines, and safety monitoring, refer to:

• U.S. Food and Drug Administration (FDA) Website: FDA.gov
• ClinicalTrials.gov – VICTORIA Trial (NCT02861534): ClinicalTrials.gov
• New England Journal of Medicine (NEJM) – VICTORIA Trial Publication: NEJM
• American Heart Association (AHA) Guidelines: Heart.org

Final Thoughts

Vericiguat (marketed as Verquvo) is an important advancement in the management of chronic heart failure with reduced ejection fraction. By stimulating soluble guanylate cyclase and increasing cGMP levels, vericiguat promotes vasodilation and improves cardiac output, thereby reducing the risk of hospitalization and cardiovascular death. Due to its potential to lower blood pressure and its contraindications with certain agents (such as nitrates and PDE5 inhibitors), vericiguat must be used with careful monitoring under the guidance of a healthcare provider.

Disclaimer: This information is provided for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider before initiating or modifying any medication regimen.