• See Also
  1. Congestive Heart Failure Management
  • Indications
  1. Fourth line agent in symptomatic chronic Heart Failure with Reduced Ejection Fraction (<45%)
  2. Vericiguat is marketed as adjunct to triple therapy (ACE/ARB, Beta Blocker, Aldosterone Antagonist)
  • Preparations
  1. Verquvo (Vericiguat)
    1. First agent in class (released in 2020)
    2. Start 2.5 mg orally once daily with food
      1. May double dose every 2 weeks, until target dose 10 mg reached, as tolerated
  • Mechanism
  1. Vasodilation and smoth Muscle relaxation via nitric oxide path and stimulation of soluble guanylate cyclase
  • Adverse effects
  1. Symptomatic Hypotension
  • Drug Interactions
  1. PDE5 Inhibitors (e.g. Viagra)
  • Efficacy
  1. Reduces hospitalization and cardiovascular death rates (but at NNT 33 at >$600/month in 2022)
  • References
  1. (2021) Presc Lett 28(4): 24
  2. Armstrong (2020) N Engl J Med 382(20):1883-93 +PMID: 32222134 [PubMed]
  3. Butler (2022) Circ Heart Fail 15(6):e009337 +PMID: 35656822 [PubMed]
  4. Elmes (2022) Am Fam Physician 106(5): 582-3 [PubMed]