riociguat
riociguat
(rye-oh-sig-ue-at ) riociguat,Adempas
(trade name)Classification
Therapeutic: pulmonary hypertension agentsPharmacologic: soluble guanylate cyclase stimulators sgs
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (improvement in 6–min walk distance)
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
PO | within 2 wk | 8–16 wk | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness (most frequent)
- headache (most frequent)
Cardiovascular
- pulmonary edema (↑ in veno-occlusive disease)
- hypotension (most frequent)
Gastrointestinal
- dyspepsia (most frequent)
- gastritis (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- constipation
- diarrhea
- gastroesopheal reflux
- ↑ liver enzymes
Hematologic
- bleeding (life-threatening)
- anemia
Interactions
Drug-Drug interaction
↑ risk of hypotension with concurrent use of nitrates, nitric oxide donors (including amyl nitrate ) or phosphodiesterase (PDE) inhibitors including specific PDE-5 inhibitors such as sildenafil, tadalafil or vardenafil and non-specific PDE inhibitors such as dipyridamole or theophylline, concurrent use is contraindicated Strong CYP and P-gp/BRCP inhibitors including azole antifungals (ketoconazole and itraconazole ) and protease inhibitors (ritonavir ) ↑ blood levels and the risk of adverse reactions including hypotension (consider ↓ initial dose).Strong CYP3A inducers including carbamazepine, phenobarbital, phenytoin and rifampin ↓ blood levels and may ↓ effectiveness.Concurrent use of antihypertensives including diuretics may ↑ risk of hypotension.Antacids ↓ absorption (separate doses by at least 1 hr)Cigarette smoking ↓ blood levels and effectiveness, ↑ dose may be necessary and dose re-adjustment required after smoking cessation.St. John's wort ↓ blood levels and may ↓ effectiveness.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Monitor hemodynamic parameters and exercise tolerance prior to and every 2 wks during therapy.
- Assess for signs and symptoms of pulmonary edema (shortness of breath). If confirmed, discontinue therapy.
- Monitor patient for bleeding (hemoptysis, vagina, catheter site, hematemesis, intra-abdominal, cerebral) during therapy.
- Lab Test Considerations: Obtain a negative pregnancy test prior to beginning, monthly during therapy, and 1 mo following treatment.
- Monitor hepatic function periodically during therapy. May cause ↑ AST, ALT, and bilirubin. If clinically relevant ↑ of AST or ALT occur, or if ↑ are accompanied by ↑ bilirubin >2 x upper limit of normal, or by clinical symptoms of hepatotoxicity, discontinue therapy. May reinitiate therapy when hepatic enzyme levels normalize in patients who have not experienced clinical symptoms of hepatotoxicity.
- Monitor CBC before starting and periodically during therapy. May cause anemia. Avoid therapy in patients with severe anemia.
Potential Nursing Diagnoses
Activity intolerance (Indications)Implementation
- Only available through a restricted program, Adempas Risk Evaluation and Mitigation Strategy (REMS). Prescribers and pharmacies must be enrolled and certified. All female patients must enroll and comply with pregnancy testing and contraception requirements. Male patients do not need to enroll.
- Oral: Administer 3 times daily. If patient at risk for hypotension, begin with 0.5 mg dose. If systolic BP >95 and patient is asymptomatic, may increase by 0.5 mg three times/day up to 2.5 mg three times daily. Do not increase sooner than every 2 wks. If symptoms of hypotension occur, decrease dose by 0.5 mg three times/day. If dose is missed more than 3 days, begin titration again.
- Titrate patients who smoke to doses >2.5 mg three times/day, if tolerated. May need to decrease dose if patient stops smoking.
- May be administered without regard to food.
Patient/Family Teaching
- Instruct patient to take riociguat as directed. If dose is missed, omit and continue with next scheduled dose.
- Advise patient to avoid taking antacids within 1 hr of riociguat.
- Advise patient to notify health care professional if they smoke.
- May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Caution female patients that riociguat may harm fetus. Instruct females to use effective contraception (intrauterine device IUD, contraceptive implants, tubal sterilization) or a combination of methods (hormone method with a barrier method or two barrier methods) during and for at least a mo following discontinuation of therapy. If a partner’s vasectomy is method of contraception, a hormone or barrier method must be used along with this method. Counsel patient on emergency contraception. May decrease sperm count in male patients. Advise female patient to notify health care professional immediately if pregnancy is suspected and avoid breastfeeding.
Evaluation/Desired Outcomes
- Increased exercise tolerance.