From the Research
Verquvo (vericiguat) is not contraindicated in patients with Chronic Kidney Disease (CKD). Patients with CKD can take Verquvo without dose adjustments, as the medication does not require specific dosing modifications based on kidney function. The standard dosing regimen starts at 2.5 mg once daily and is titrated to a target dose of 10 mg once daily, regardless of kidney function status. This is particularly beneficial for heart failure patients who often have concurrent kidney disease. The pharmacokinetics of vericiguat are not significantly altered by reduced kidney function, as the drug is primarily eliminated through non-renal pathways. However, patients with severe kidney impairment (eGFR <15 mL/min/1.73m²) or on dialysis should be monitored closely as clinical experience in these populations is limited. It's essential to consider the findings from the VICTORIA trial, which showed that vericiguat reduced the primary composite outcome of cardiovascular death or heart failure hospitalization in patients with worsening HF with reduced ejection fraction, and the beneficial effects of vericiguat were consistent across the full range of eGFR 1. Additionally, a review of vericiguat highlighted its efficacy and safety in patients with symptomatic chronic heart failure and ejection fraction less than 45% 2. While kidney function does not affect Verquvo dosing, the medication is absolutely contraindicated in pregnancy and in patients taking other soluble guanylate cyclase (sGC) stimulators like riociguat.
Some key points to consider when prescribing Verquvo to patients with CKD include:
- Monitoring patients with severe kidney impairment or on dialysis closely due to limited clinical experience in these populations
- Being aware of the potential for worsening renal function, which was associated with worse outcomes in the VICTORIA trial 1
- Considering the benefits of vericiguat in reducing cardiovascular death and heart failure hospitalization in patients with symptomatic chronic heart failure and ejection fraction less than 45% 2, 3
- Ensuring that patients are not taking other soluble guanylate cyclase (sGC) stimulators like riociguat, as this is an absolute contraindication.