Adempas (Riociguat) – Oral

Warning:

Do not take Adempas while pregnant, as it may harm the fetus. Females with reproductive potential should avoid becoming pregnant before starting Adempas, test for pregnancy monthly during treatment, and use two contraceptive methods during treatment and one month after treatment to prevent pregnancy.

What Is Adempas?

Adempas (riociguat) is a prescription medication used to treat a unique type of high blood pressure in the lungs known as pulmonary hypertension. It belongs to a class of medications known as soluble guanylate cyclase stimulators.

Riociguat works by relaxing the blood vessels in the lungs, allowing the blood to flow more easily. This helps slow symptoms from worsening and increases exercise capacity.

Adempas is available in tablet form to be taken by mouth.

Drug Facts

Generic Name: Riociguat

Brand Name(s): Adempas

Drug Availability: Prescription

Therapeutic Classification: Soluble guanylate cyclase (sGC) stimulator

Available Generically: Yes

Controlled Substance: No

Administration Route: Oral

Active Ingredient: Riociguat

Dosage Form(s): Tablet

What Is Adempas Used For?

Adempas is used to treat and prevent the worsening of high blood pressure in the lungs in adults with chronic thromboembolic pulmonary hypertension or pulmonary arterial hypertension.

Riociguat helps improve exercise capacity or the oxygen supply from the lungs to the heart. The oxygen supply plays a crucial role in the efficiency of our heart pumping blood. Riociguat has proven beneficial in people with a reduced exercise capacity, such as those who are at risk of a heart attack or live with chronic obstructive pulmonary (lung) disease (COPD).

How to Take Adempas

Take Adempas by mouth and exactly as prescribed by your healthcare provider, which is usually three times per day (about six to eight hours apart).

Adempas comes in oral tablets and can be taken with or without food. If you cannot swallow pills, you may crush the tablet and mix it with water or soft foods (e.g., applesauce) right before taking it.

Always speak with your healthcare provider before taking this medication or any other prescribed medication.

Storage

Store the tablets in their original bottle and keep the lid tightly closed at all times to protect them from moisture. Keep the container at room temperature (between 68 and 77 degrees F).

Take care not to leave your medication anywhere it may be exposed to temperatures outside of its storage range, such as in your car or in the refrigerator. Keep it in a dry and safe area out of reach of children and pets to prevent accidental consumption.

Off-Label Uses

Uses of this product are generally limited to chronic or persistent forms of high blood pressure in the heart and lungs. Your healthcare provider may prescribe it for other uses, such as if you have certain surgeries that may affect the heart or lungs.

How Long Does Adempas Take to Work?

Adempas may take a few hours to take effect. The greatest effect of this medication may occur in as little as 1.5 hours after consumption. After taking it, the drug may stay in your body for about 12 to 48 hours, depending on your health status. Food will not interfere with its effects or timing of absorption.

What Are the Side Effects of Adempas?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

This medication, like many others, comes with side effects. Possible side effects may be mild or severe.

Common Side Effects

Common side effects reported with this medication include:

  • Headache
  • Stomach discomfort
  • Bloating
  • Gastroesophageal reflux disease (GERD)
  • Swelling in hands, legs, feet or ankles
  • Dizziness
  • Nausea and vomiting
  • Diarrhea
  • Low blood pressure
  • Constipation

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Low blood pressure: This can cause dizziness, light-headedness, or fainting.
  • Bleeding: Tell your healthcare provider if you cough up blood.
  • Worsening of pulmonary veno-occlusive disease (PVOD) symptoms: In people with PVOD, Adempas can cause fluid to build up in the lungs (pulmonary edema), which may cause shortness of breath.

Adempas also carries a boxed warning regarding the potential for serious fetal harm. A boxed warning is the FDA's strictest safety warning for a prescription medication label. For this reason, it should not be used during pregnancy.

Long-Term Side Effects

Riociguat does not appear to cause any long-term side effects, although further research is needed to evaluate the use of this medication fully.

Report Side Effects

Adempas may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Adempas Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension:
      • Adults—At first, 1 milligram (mg) 3 times a day. Other patients may start at 0.5 mg 3 times a day. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 2.5 mg 3 times a day.
      • Children—Use and dose must be determined by your doctor.

Modifications

The following changes (modifications) should be considered when using Adempas.

Children

The safety and efficacy of Adempas in children have not yet been fully established, so this medication has not been approved for use in this population.

Advanced Age

There is no definitive distinction between younger and older adults (65 years and older) while using this medication. However, there is generally a greater sensitivity in older adults regarding medication side effects. Talk to your healthcare provider before starting this medication if you are concerned.

People Who Smoke

People who smoke can take Adempas; however, they may need a dose adjustment as smoking can reduce the effects of Adempas. If you are a smoker or start smoking, speak with your healthcare provider before starting this medication so they can prescribe the proper dose.

Nonsmokers may also be at risk if they are experiencing or are at risk for low blood pressure. It is important to check your blood pressure daily to avoid any problems with your medication, whether you smoke or stop smoking.

Missed Dose

If you miss a dose of your Adempas, do not take it again. Wait for your next dose or the next day to continue your current regimen. Do not take a second dose, as it may provide more harm than good.

If you have trouble remembering when to take your medication, try to write it down somewhere you will see it, or use a pill box. If you are on a higher dose of Adempas and miss three or more days' worth of doses, talk to your healthcare provider immediately. You may need to restart at a lower dose.

Overdose: What Happens If I Take Too Much Adempas?

Adempas can directly affect your blood pressure. If you accidentally take more than prescribed, check your blood pressure regularly to ensure it doesn't drop too low. Low blood pressure can cause dizziness, light-headedness, and fainting.

Contact your healthcare provider if you start to experience signs of extremely low blood pressure.

What Happens If I Take Too Much Adempas?

If you think you or someone else may have overdosed on Adempas, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Adempas, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects. Blood tests may be needed to check for unwanted effects. Your blood pressure should be checked by your doctor every 2 weeks while taking this medicine.

Using this medicine while you are pregnant can cause very serious birth defects. Use a highly effective form of birth control or 2 forms of effective birth control to keep from getting pregnant while you are using this medicine and for at least 1 month after your last dose. The most effective forms of birth control are hormone birth control pills, patches, shots, vaginal rings, or implants, or a vasectomy (for men). One of these forms of birth control should be combined with a condom, a diaphragm, or a cervical cap. If a woman has had a tubal ligation or has an IUD, she does not need to use a second form of birth control. If you think you have become pregnant while using this medicine, tell your doctor right away.

If you are a woman who can get pregnant, you must have a negative pregnancy test before you will be allowed to take this medicine. You will also be required to have a pregnancy test every month during your treatment and for 1 month after treatment with this medicine. If you miss a period while you are using this medicine, tell your doctor right away.

Do not use this medicine together with a nitrate medicine (eg, nitroglycerin) or nitric oxide donor (eg, amyl nitrite). Do not use this medicine together with dipyridamole, theophylline, or medicine for impotence (eg, sildenafil, tadalafil, vardenafil). Using these medicines together may cause hypotension (low blood pressure).

This medicine could lower your blood pressure and cause you to feel dizzy or lightheaded. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. If you feel dizzy, lie or sit down so you do not faint.

Pulmonary edema (swelling in your lungs) may occur with this medicine. Check with your doctor right away if you have chest pain, difficult, fast, or noisy breathing, blue lips and fingernails, pale skin, increased sweating, coughing that sometimes produces a pink frothy sputum, or shortness of breath.

Tell your doctor if you smoke before taking this medicine.

Do not take other medicines unless thy have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn’t Take Adempas?

An allergy or sensitivity to riociguat is rare but can happen. If you experience signs of an allergic reaction after taking Adempas, immediately alert your healthcare provider or pharmacist.

Do not take this medication if you are pregnant. Adempas can cause harm to a developing fetus. Talk with your provider about other options for blood pressure management.

You should also avoid breastfeeding while taking Adempas, as it is not fully known whether the drug passes into human breast milk.

What Other Medications Interact With Adempas?

Before starting Adempas, tell your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

Adempas should be carefully administered when taking certain medications.

Do not take antacids (e.g., aluminum hydroxide or magnesium hydroxide) within one hour of taking Adempas.

Certain medications used for erectile dysfunction can dangerously drop blood pressure when used with Adempas. Careful administration is recommended with the following:

  • Viagra (sildenafil): Do not take Adempas within 24 hours of taking Viagra.
  • Cialis (tadalafil): Do not take Adempas 24 hours before or within 48 hours of taking Cialis.
  • Levitra (vardenafil): Do not take Levitra with Adempas.

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Adempas.

What Medications Are Similar?

Adempas is a soluble guanylate cyclase (sGC) stimulator, which is a drug class unique to its kind. There are not many medications in this class, but they and other medications with effects on blood pressure, such as nitrates or nitric oxide donors and PDE-5 inhibitors (erectile dysfunction medications) should be avoided if you are already taking Adempas.

Other medications that affect blood pressure include:

Frequently Asked Questions

  • What is Adempas used for?

    Adempas is used to treat more complex high blood pressure issues dealing with the lungs and the heart's blood vessels. It can improve your oxygen supply to reduce blood pressure and improve overall heart health.

  • How does Adempas work?

    Adempas works by stimulating factors associated with nitric oxide, which decreases blood pressure and relaxes the blood vessels in the heart and lungs for better oxygen supply.

  • What drugs should not be taken with Adempas?

    Drugs associated with the same class or have properties that include increasing nitric oxide or increased blood flow, such as erectile dysfunction medications, should be avoided or carefully monitored while taking Adempas.

    These medications include:

    • Verquvo (vericiguat)
    • Viagra (sildenafil)
    • Cialis (tadalafil)
    • Nitroglycerin 
    • Amyl nitrate
  • How long does it take for Adempas to work?

    This medication may take a few hours depending on the dose, and peak effects of this medication can be seen as soon as 1.5 hours upon taking it.

  • How to stop taking Adempas?

    Do not stop taking Adempas unless you are about to become pregnant or find out you are already pregnant. Always consult with your healthcare provider before discontinuing your medication.

  • Should I stop my other medications while taking Adempas?

    Do not stop taking your other medications unless directed by your healthcare provider first. You should never begin taking a new medication or supplement unless directed by your primary care provider.

How Can I Stay Healthy While Taking Adempas?

It is always best to maintain a healthy diet and exercise as often as possible. Speak with your primary care provider before starting a new workout regimen, and always avoid high-sodium, processed foods when taking any blood pressure medications. This will increase your likelihood of controlling your high blood pressure and improving your general health.

It may be difficult to find time to exercise. However, you can start by simply walking 30 minutes a day for about three to four days and slowly increase the frequency or intensity. Consult with your healthcare provider before starting any new exercise regimen.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some drug content, as indicated on the page.

The author would like to recognize and thank Jaycob Pena for contributing to this article.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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