Riociguat Tablets (Adempas), as a soluble guanylate cyclase stimulant, hold an important position in the treatment of chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension.
Precautions for the Administration of Riociguat Tablets (Adempas)
Absolute Contraindication During Pregnancy
Based on data from animal reproductive studies, riociguat has a confirmed teratogenic effect on the fetus.
Pregnancy status must be ruled out before any medication use, and strict contraception is required during treatment and for 1 month after discontinuing the drug.
Contraindications for Drug Interactions
Concurrent use with nitrates or nitric oxide donors is prohibited, and simultaneous administration with phosphodiesterase inhibitors should be avoided.
An interval of at least 24 hours must be maintained when using sildenafil, and an interval of 48 hours when using tadalafil.
Concurrent use with other soluble guanylate cyclase stimulants is also prohibited.
Contraindications for Specific Disease Types
Patients with pulmonary arterial hypertension associated with idiopathic interstitial pneumonia are prohibited from using this drug.
Management of Embryo-Fetal Toxicity Risks
All female patients must enroll in the Riociguat Risk Evaluation and Mitigation Strategy (REMS) program.
Females of reproductive potential need to undergo pregnancy testing before treatment, monthly during treatment, and for 1 month after discontinuing the drug.
Prevention and Control of Symptomatic Hypotension
Riociguat can cause a decrease in blood pressure. Enhanced monitoring is required for patients with hypovolemia, severe left ventricular outflow tract obstruction, or those taking antihypertensive drugs.
It is recommended that susceptible patients start treatment with an initial dose of 0.5 mg.
Identification of Pulmonary Venous Occlusive Disease
Pulmonary vasodilators may significantly worsen the cardiovascular status of patients with pulmonary venous occlusive disease.
If signs of pulmonary edema appear, the possibility of pulmonary venous occlusive disease should be considered, and the drug should be discontinued promptly.
Medication Monitoring for Riociguat Tablets (Adempas)
Efficacy Evaluation Indicators
The main indicators for efficacy evaluation include the improvement in 6-minute walk distance, changes in WHO functional class, and the delaying effect on the time to clinical deterioration.
Safety Monitoring Parameters
Regularly monitor changes in blood pressure, hemoglobin levels, and liver function indicators.
Pay special attention to common adverse reactions such as headache, dyspepsia, dizziness, and nausea.
Laboratory Test Monitoring
Regular testing of NT-proBNP levels is required to assess the improvement in hemodynamic parameters.
Patients with Hepatic or Renal Insufficiency
Use is not recommended for patients with a creatinine clearance rate < 15 mL/min or those undergoing dialysis.
Use is contraindicated in patients with severe hepatic insufficiency.
Female Patients of Childbearing Age
Strict compliance with contraceptive requirements is mandatory; two effective contraceptive methods should be used to ensure effective contraception during treatment and for 1 month after discontinuing the drug.
Patient Education and Guidance
Patients should be informed about the correct medication administration method, potential adverse reactions, and how to handle emergency situations.
Emphasize that the drug must not be taken simultaneously with antacids, and an interval of at least 1 hour must be maintained.
