AdultPediatricDosage Forms & Strengths tablet 2.5mg 5mg 10mg Heart Failure Risk Reduction Indicated to reduce risk of cardiovascular death and heart failure (HF) hospitalization following a hospitalization for HF or need for outpatient IV diuretics, in adults with symptomatic chronic HF and ejection fraction <45% Initial: 2.5 mg PO qDay Maintenance: Double dose ~q2Weeks as tolerated to target dose of 10 mg PO qDay Dosage Modifications Renal impairment eGFR ≥15 mL/min/1.73m2 and not on dialysis: No dosage adjustment necessary eGFR <15 mL/min/1.73m2 or on dialysis: Not studied Hepatic impairment Mild or moderate (Child-Pugh A or B): No dosage adjustment necessary Severe (Child-Pugh C): Not studied Dosing Considerations Obtain pregnancy test in females of reproductive potential before initiatingSafety and efficacy not establishedInteraction CheckerEnter a drug name and vericiguatNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (5)avanafilavanafil, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration of vericiguat with PDE-5 inhibitors may result in additive hypotensive effects.riociguatriociguat, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Vericiguat is contraindicated with use of other soluble guanylate cyclase (sGC) stimulators.sildenafilsildenafil, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration of vericiguat with PDE-5 inhibitors may result in additive hypotensive effects.tadalafiltadalafil, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration of vericiguat with PDE-5 inhibitors may result in additive hypotensive effects.vardenafilvardenafil, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration of vericiguat with PDE-5 inhibitors may result in additive hypotensive effects.Serious - Use Alternative (0)Monitor Closely (0)Minor (0)avanafilContraindicated (1)avanafil, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration of vericiguat with PDE-5 inhibitors may result in additive hypotensive effects.riociguatContraindicated (1)riociguat, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Vericiguat is contraindicated with use of other soluble guanylate cyclase (sGC) stimulators.sildenafilContraindicated (1)sildenafil, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration of vericiguat with PDE-5 inhibitors may result in additive hypotensive effects.tadalafilContraindicated (1)tadalafil, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration of vericiguat with PDE-5 inhibitors may result in additive hypotensive effects.vardenafilContraindicated (1)vardenafil, vericiguat. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration of vericiguat with PDE-5 inhibitors may result in additive hypotensive effects. >10% Hypotension (16%); placebo (15%) 1-10% Anemia (10%); placebo (7%) Black Box Warnings Females of reproductive potential May cause fetal harm; do not administer to pregnant females Exclude pregnancy before starting treatment To prevent pregnancy, females of reproductive potential must use effective forms of contraception during treatment and for 1 month after stopping treatment Contraindications Coadministration with other soluble guanylate cyclase (sGC) stimulators Pregnancy Cautions Based on data from animal reproduction studies, may cause fetal harm when administered to pregnant females and its use is contraindicated Drug interaction overview Coadministration with other sGC stimulators is contraindicated Coadministration with PDE-5 inhibitors not recommended owing to potential for hypotension Pregnancy Contraindicated; based on data from animal reproduction studies, may cause fetal harm when administered to pregnant females There are no available data regarding use in pregnant females Verify pregnancy status in females of reproductive potential before initiating If patient becomes pregnant during treatment, report drug exposure by calling 1-877-888-4231 or at https://pregnancyreporting.4verquvo-us.com Animal studies Administration to pregnant rabbits during organogenesis at ≥4 times the human exposure (total AUC) with the maximum recommended human dose (MRHD) of 10 mg resulted in malformations of the heart and major vessels, as well as increased number of abortions and resorptions In a prenatal/postnatal toxicity study, oral administration to rats during gestation through lactation caused maternal toxicity, resulting in decreased pup body weight gain (≥10 times the MRHD) and increased pup mortality (24 times the MRHD) during the preweaning period Contraception Advise females of reproductive potential to use effective contraception during treatment and for 1 month after final dose Lactation Data are not available on the presence of vericiguat in human milk, effects on breastfed infants, or effects on milk production Vericiguat is present in the milk of lactating rats and it is likely that vericiguat or its metabolites are present in human milk Owing to the potential for serious adverse reactions in breastfed infants, advise women not to breastfeed during treatmentPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Stimulates soluble guanylate-cyclase (sGC), the intracellular receptor for endogenous nitric oxide (NO), which catalyzes cyclic guanosine monophosphate (cGMP) production; cGMP plays a role in the regulation of vascular tone, cardiac contractility, and cardiac remodeling Heart failure is associated with impaired NO synthesis and decreased sGC activity, which may contribute to myocardial and vascular dysfunction By directly stimulating sGC, independently of and synergistically with NO, vericiguat augments levels of intracellular cGMP, leading to smooth muscle relaxation and vasodilation Absorption Bioavailability: 93% when taken with food Peak plasma time: 4 hr (with food) Peak plasma concentration: 350 mcg/L AUC: 6680 mcg⋅h/L Steady-state achieved after ~6 days Effect of food With high-fat, high-calorie meal Peak plasma time: 1 hr (fasting); 4 hr (fed) Peak plasma concentration: Increased by 41% AUC: Increased by 44% Distribution Vd: 44 L (healthy volunteers) Protein bound: ~98% Metabolism Primarily undergoes glucuronidation by UGT1A9 and to a lesser extent by UGT1A1 to form an inactive N-glucuronide metabolite CYP-mediated metabolism is a minor clearance pathway (<5%) Elimination Half-life: 30 hr (patients with HF) Clearance: 1.6 L/hr (healthy volunteers) Excretion, healthy volunteers Urine: ~53% (primarily as inactive metabolite) Feces: 45% (primarily as unchanged drug) Oral Administration Take with food to improve bioavailability Swallow table whole Difficulty swallowing If unable to swallow tablet whole, may crush and mix with water immediately before administration Missed dose Take missed dose as soon as remembered on the same day of the missed dose Do not take 2 doses on the same day to make up for a missed dose Storage Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions Tier Description 1 This drug is available at the lowest co-pay. 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