From the Guidelines
Riociguat is associated with a low risk of fluid retention, and its use should be considered in patients with pulmonary arterial hypertension, with careful monitoring and management of potential side effects. This medication, used primarily for pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension, works by stimulating soluble guanylate cyclase, leading to vasodilation. According to the study by Humbert et al 1, riociguat has been shown to improve 6-minute walk distance, hemodynamics, and WHO functional class in patients with systemic sclerosis-associated pulmonary arterial hypertension.
Key Points to Consider
- Riociguat can cause fluid retention as a side effect in some patients, typically manifesting as peripheral edema, weight gain, or in more severe cases, pulmonary edema.
- The risk of fluid retention with riociguat is considered low, as noted in the study by Humbert et al 1, which found a significant improvement in 6-minute walk distance and hemodynamics without a significant increase in fluid retention.
- Management strategies for fluid retention may include reducing the dose, adding a diuretic like furosemide (20-40 mg daily), or implementing sodium restriction (less than 2 grams daily) 1.
- Regular weight monitoring is recommended, with gaining more than 2 kg (4.4 lbs) in a short period warranting medical attention.
- Patients with pre-existing heart failure or kidney disease should be monitored more closely, as they have a higher risk for fluid retention and other side effects.
Clinical Implications
- Riociguat should be considered as a treatment option for patients with pulmonary arterial hypertension, particularly those who have not responded to other therapies or have contraindications to other medications.
- Healthcare providers should carefully monitor patients for signs of fluid retention and adjust the treatment plan as needed to minimize the risk of this side effect.
- The benefits of riociguat in improving symptoms and quality of life for patients with pulmonary arterial hypertension should be weighed against the potential risks, including fluid retention, and patients should be closely monitored and managed accordingly.
From the Research
Relationship between Riociguat and Fluid Retention
- The studies provided do not directly investigate the relationship between Riociguat (Adempas) and fluid retention as a primary outcome.
- However, some studies mention edema or peripheral edema as adverse events associated with Riociguat treatment 2.
- In the EXPERT registry study, edema/peripheral edema was reported as one of the most common adverse events in patients with pulmonary arterial hypertension, affecting 10.7% of patients 2.
- There is no detailed analysis of the relationship between Riociguat and fluid retention in the provided studies, suggesting that further research may be needed to fully understand this potential association 3, 4, 5, 6.