Riociguat Tablets (Adempas) are a soluble guanylate cyclase (sGC) stimulant, used for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) in adults.
How to Use Riociguat Tablets (Adempas)
Routine Dosage for Adults
Initial dose: 1 mg, taken orally three times a day.
Dose escalation: Increase the dose by 0.5 mg every 2 weeks, with the maximum dose not exceeding 2.5 mg three times a day.
Patients with low tolerance: For patients who may not tolerate the blood pressure-lowering effect, an initial dose of 0.5 mg may be considered.
Precautions for Administration
Take the tablet whole, or crush it and mix with water/soft food (e.g., applesauce) before administration.
Maintain an interval of 6-8 hours between each daily dose.
The medication can be taken with food or on an empty stomach.
Dose Adjustment of Riociguat Tablets (Adempas)
Routine Dose Adjustment
Escalation criterion: Dose increase is only permitted when the systolic blood pressure remains > 95 mmHg and there are no symptoms of hypotension.
De-escalation indication: When symptoms of hypotension occur, the dose must be reduced by 0.5 mg immediately.
Management of treatment interruption: If treatment is interrupted for ≥ 3 days, dose titration must be restarted.
Dose Adjustment Under Special Circumstances
Concomitant use with strong CYP and P-gp/BCRP inhibitors: An initial dose of 0.5 mg should be considered.
Closely monitor for symptoms of hypotension during the medication period.
Medication for Special Populations with Riociguat Tablets (Adempas)
Women of Childbearing Age
Strict contraception: Effective contraceptive measures must be used during treatment and for 1 month after discontinuing the medication.
Pregnancy testing: Pregnancy tests are required before treatment, monthly during treatment, and for 1 month after treatment cessation.
Risk management: Must enroll in the Adempas REMS (Risk Evaluation and Mitigation Strategy) program.
Patients with Hepatic or Renal Insufficiency
Severe renal insufficiency: Not recommended for patients with a creatinine clearance < 15 mL/min or those undergoing dialysis.
Severe hepatic impairment: Not recommended for patients with Child-Pugh Class C hepatic impairment.
Smoking Patients
The plasma concentration of the drug in smoking patients is reduced by 50-60%.
A dose higher than 2.5 mg three times a day may be required (if tolerated).
Dose reduction should be considered after smoking cessation.
Medication Switch Management
Switching from phosphodiesterase inhibitors:
Sildenafil: Discontinue use for at least 24 hours before switching.
Tadalafil: Discontinue use for at least 48 hours before switching.
Monitor for symptoms of hypotension during the switching period.
