II. 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)

III. 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

IV. Mechanism

  1. Vasodilation and smoth Muscle relaxation via nitric oxide path and stimulation of soluble guanylate cyclase

V. Adverse effects

  1. Symptomatic Hypotension

VI. Drug Interactions

VII. Efficacy

  1. Reduces hospitalization and cardiovascular death rates (but at NNT 33 at >$600/month in 2022)

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