Viliximab increases intracellular cGMP levels, relaxes smooth muscles, reduces cardiac burden, and slows down the development of heart failure.

1、 Drug name

1. Common name: Vericiguat

2. Product Name: VERQUVO

2、 Indications

Used to reduce the risk of cardiovascular death and hospitalization due to heart failure in adult patients with symptomatic chronic heart failure (ejection fraction below 45%), the applicable population is those who have recently experienced heart failure hospitalization events or those who require outpatient intravenous diuretic treatment for worsening heart failure events.

3、 Specifications

10mg * 98 pieces/box.

4、 Main components

The active ingredient is Vericiguat.

5、 Usage and dosage

1. Standard starting dose: 5mg, once daily, taken orally with meals.

2. Initial dose for patients at risk of hypotension: 2.5mg, once daily, taken orally with meals.

3. Target maintenance dose: 10mg, once daily.

4. Dose escalation: The dose is doubled every approximately 2 weeks and gradually increased to the target dose, subject to patient tolerance.

5. For those with swallowing difficulties: Crush the pill and mix it with water before taking it immediately.

6、 Dose adjustment

1. Renal insufficiency: eGFR ≥ 15mL/min/1.73m ² and non dialysis patients do not require dose adjustment. EGFR<15mL/min/1.73m ² or lack of research data for dialysis patients.

2. Liver dysfunction: Mild to moderate (Child Pugh A or B) does not require dose adjustment; Severe (Child Pugh C) lacks research data.

3. Elderly patients: No need to adjust dosage.

7、 Medication precautions

1. Meal time requirement: Must be taken with meals. When taken with a high-fat, high calorie meal, the drug exposure (AUC) increased by 44%, peak concentration increased by 41%, and pharmacokinetic variability was reduced. Taking it on an empty stomach will significantly reduce absorption.

2. Omission handling: If remembered on the same day, it should be replenished as soon as possible; But it is not allowed to take two doses on the same day.

3. Vomiting treatment: If vomiting occurs, it is recommended to consult a doctor or pharmacist.

4. Pregnancy testing: Women with fertility must undergo pregnancy testing before initiating treatment.

5. Contraceptive requirements: Women with fertility must use effective contraceptive measures during treatment and for at least one month after discontinuing medication.

6. Breastfeeding: It is not recommended to breastfeed during treatment

8、 Medication for special populations

1. Pregnant women: prohibited for pregnant women. In animal experiments, fetal heart and large vessel malformations, miscarriage, and increased absorption of fetuses were observed at ≥ 4 times the human exposure level.

2. Breastfeeding women: breastfeeding is not recommended. In animal experiments, Viliximab can be secreted into breast milk.

3. Women with fertility: Pregnancy status should be confirmed before treatment, and effective contraception should be used during the treatment period and one month after discontinuation of medication.

4. Children: Safety and efficacy have not yet been established.

5. Elderly: Patients aged 65 and above do not need to adjust their dosage. In clinical trials, 63% of patients were aged 65 years or older and 31% were aged 75 years or older, and no overall safety or efficacy differences were observed.

6. Patients with renal insufficiency: eGFR ≥ 15mL/min/1.73m ² and without dialysis do not require adjustment. EGFR<15 or lack of data for dialysis patients.

7. Patients with liver dysfunction: mild to moderate without adjustment; Severe lack of data.

9、 Adverse reactions

Common adverse reactions (incidence ≥ 5%): hypotension, anemia.

10、 Contraindications

1. Used in combination with other soluble guanylate cyclase agonists.

2. Pregnant women.

11、 Drug interactions

1. Prohibition of co use: Other soluble guanylate cyclase agonists.

2. Not recommended for combination: Phosphodiesterase-5 inhibitors (such as sildenafil) may increase the risk of hypotension.

3. Safe combination: Aspirin (500mg single dose), warfarin (25mg single dose), sacubitril/valsartan, short acting and long-acting nitrates (note that experience with long-acting nitrates is limited).

4. Gastric pH regulating drugs: When used in combination with proton pump inhibitors or antacids, taking them on an empty stomach can reduce the exposure of Viliximab by about 30%; However, no clinically significant effects were observed when taken with meals.

5. Other co uses: No clinically significant effects were found when combined with metformin (UGT1A9 inhibitor), ketoconazole, rifampicin, digoxin, sildenafil, etc.

12、 Storage method

From 20 ℃ to 25 ℃, short-term fluctuations between 15 ℃ and 30 ℃ are allowed.

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