Heart Failure Pregnancy: Contraindicated in pregnancy. Based on animal reproduction studies it may cause fetal harm - oral administration to pregnant rabbits during organogenesis at 4 or more times human exposure at the maximum recommended human dose of 10 mg produced malformations of the heart and major vessels and increased abortions and resorptions. No available data in pregnant women. Obtain a pregnancy test before starting treatment and advise females of reproductive potential to use effective contraception during treatment and for at least one month after the final dose. A Pregnancy Surveillance Program monitors pregnancy outcomes after exposure.

Vericiguat

Brand names: Verquvo

Vericiguat is an oral soluble guanylate cyclase stimulator used to treat symptomatic chronic heart failure with reduced ejection fraction following a worsening event.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 5 mg starting dose (2.5 mg starting dose for patients at risk of symptomatic hypotension); target maintenance dose 10 mg

Route: oral, with food

Frequency: once daily

Max: 10 mg once daily (target maintenance dose)

US prescribing information (VERQUVO): the recommended starting dose is 5 mg orally once daily with food; for patients at risk of symptomatic hypotension the recommended starting dose is 2.5 mg orally once daily with food. Double the dose approximately every 2 weeks to reach the target maintenance dose of 10 mg once daily, as tolerated by the patient. For patients unable to swallow whole tablets, the tablets may be crushed and mixed with water immediately before administration. Obtain a pregnancy test in females of reproductive potential prior to initiating treatment. Available strengths: 2.5 mg, 5 mg and 10 mg tablets. Geriatric use: no dosage adjustment required. Paediatric use: safety and effectiveness have not been established in paediatric patients. NO UK SPC WAS RETURNED IN THE BUNDLE - this dose is taken from US labelling (Merck Sharp & Dohme LLC, label date 2026-01-21) and must be verified against the UK SPC. No renal or hepatic dose adjustment appears in the fetched sections.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Concomitant use of other soluble guanylate cyclase (sGC) stimulators
Pregnancy

Side effects

Hypotension (16% vs 15% placebo in VICTORIA; most common reported reaction)
Anaemia (10% vs 7% placebo in VICTORIA)

Interactions

Other soluble guanylate cyclase (sGC) stimulators - contraindicated
PDE-5 inhibitors - concomitant use is not recommended because of the potential for hypotension

Clinical monograph

How it works

It directly stimulates soluble guanylate cyclase and enhances its sensitivity to nitric oxide, increasing cyclic GMP to promote vasodilatation and improve myocardial and vascular function.

Prescribing in practice

Contraindicated in pregnancy because of evidence of foetal harm, and effective contraception is required in those who can become pregnant.
Avoid co-administration with other soluble guanylate cyclase stimulators and with PDE5 inhibitors owing to additive hypotensive effects.
It is intended as an add-on to optimised guideline-directed heart failure therapy rather than a replacement for it.

Monitoring

Monitor blood pressure for symptomatic hypotension, particularly during initiation and uptitration.

Counselling the patient

Take with food to improve absorption and tolerability.
Report dizziness, light-headedness or fainting, which may indicate low blood pressure.
Discuss contraception and pregnancy plans before and during treatment.

Evidence & guidelines

The VICTORIA trial showed vericiguat reduced the composite of cardiovascular death or heart failure hospitalisation in high-risk patients with worsening heart failure with reduced ejection fraction.

Reference: VICTORIA trial NEJM 2020; 382(20):1883-1893; NICE TA940; MHRA 2022; ESC HF Guidelines 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

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