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Soluble Guanylate Cyclase Stimulator

Riociguat

Brand names: Adempas

Riociguat is a soluble guanylate cyclase stimulator licensed for pulmonary arterial hypertension and inoperable or persistent chronic thromboembolic pulmonary hypertension.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It both sensitises soluble guanylate cyclase to endogenous nitric oxide and directly stimulates the enzyme, increasing cyclic GMP and producing pulmonary vasodilatation.

Prescribing in practice

  • Contraindicated with phosphodiesterase-5 inhibitors and with nitrates or nitric oxide donors because of the risk of severe hypotension.
  • It is contraindicated in pregnancy and requires effective contraception, with a pregnancy prevention programme in women of childbearing potential.
  • Avoid in patients with pulmonary hypertension associated with idiopathic interstitial pneumonias.

Monitoring

Monitor blood pressure and for symptoms of hypotension during initiation and titration.

Counselling the patient

  • Do not take erectile dysfunction medicines or nitrate-containing products with this drug.
  • Effective contraception is essential; this medicine can harm an unborn baby.
  • Report dizziness or light-headedness, which may indicate low blood pressure.

Evidence & guidelines

Riociguat is supported by the PATENT and CHEST randomised trials in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension respectively.

Reference: CHEST-1 (Ghofrani et al, NEJM 2013); PATENT-1 (Ghofrani et al, NEJM 2013); NICE TA310; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways