Vericiguat

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.