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Adempas

riociguat
Used for Pulmonary Hypertension
Used for Pulmonary Hypertension

Adempas (riociguat) is a medication used to treat adults with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), both of which are types of high blood pressure in the lungs. It's available as tablets taken by mouth every 8 hours. Common side effects include headache, indigestion, and dizziness. Adempas (riociguat) can also cause severe and life-threatening harm to unborn babies, so the medication is only available to females through the Adempas REMS program.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Kristianne Hannemann, PharmD
Last reviewed on July 23, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsContraindicationsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Adempas (riociguat)?

What is Adempas (riociguat) used for?

How Adempas (riociguat) works

Adempas (riociguat) is a soluble guanylate cyclase (sGC) stimulator. It works by activating sGC, a protein that helps relax the blood vessels in the lungs and allows more blood to flow through. As a result, your heart is able to pump better, your body gets more oxygen, and you should be able to breathe and exercise easier.

Drug Facts

Common BrandsAdempas
Drug ClassSoluble guanylate cyclase (sGC) stimulator
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Adempas (riociguat)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Headache (27%)
  • Indigestion or stomach irritation (21%)
  • Dizziness (20%)
  • Nausea (14%)
  • Diarrhea (12%)
  • Low blood pressure (10%)
  • Vomiting (10%)
  • Anemia (7%)
  • Reflux or heartburn (5%)
  • Constipation (5%)

Other Side Effects

  • Stuffy nose
  • Nosebleed
  • Difficulty swallowing
  • Bloating
  • Fluid build-up (edema) in arms or legs

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Dangerously low blood pressure: dizziness, lightheadedness, pale skin, feeling faint
  • Severe bleeding: feeling faint, lightheadedness, dizziness, vomiting blood, bloody or dark-colored stools, severe stomach pain or discomfort
  • Blockage in the lungs: dizziness, trouble breathing, irregular heartbeat, chest pain, sweating, coughing

Source: DailyMed

More on Adempas (riociguat) side effects

Pharmacy: side effects adempas

8 Adempas (Riociguat) Side Effects and How to Manage Them

Written by Brian Leonard, PharmD, BCACP, BCGP

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Confusion

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

nosebleeds

unusual tiredness or weakness

Less common

Bloating or swelling of the face, arms, hands, lower legs, or feet

bloody or black, tarry stools

bruising or purple areas on the skin

coughing or spitting up blood

decreased alertness

fast, irregular, pounding, or racing heartbeat or pulse

heavy non-menstrual vaginal bleeding

rapid weight gain

stomach pain or swelling

troubled breathing with exertion

vomiting of blood or material that looks like coffee grounds

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Diarrhea

headache

heartburn

indigestion

nausea

stuffy nose

vomiting

Less common

Difficulty having a bowel movement

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Adempas (riociguat)

thumbs-up

Pros

Makes it easier to exercise and perform normal day-to-day activities

Taken by mouth

Can crush and mix with water or soft foods if you're having difficulty swallow pills

thumbs-down

Cons

Not safe to use while pregnant or breastfeeding

Taken 3 times per day

Can lower your blood pressure and cause bleeding

pharmacist-tips

Pharmacist tips for Adempas (riociguat)

pharmacist

  • Make sure to mark your appointments on your calendar for when you need to see your provider. These appointments are important to discuss how treatment is going for you and to make sure Adempas (riociguat) is safe for you to take.

    • Take Adempas (riociguat) with or without food at the same time every day. But Adempas (riociguat) commonly causes nausea, so taking it with food might help reduce stomach side effects.

      • If you're having trouble swallowing the tablets, you can crush them and mix with water or soft foods such as applesauce right before taking your dose.

        • Adempas (riociguat) can lower your blood pressure and make you dizzy. Make sure to stay hydrated. Don't drive or operate machinery until you know how this medication affects you. Let your provider know if you're taking medication for high blood pressure and if you feel lightheaded, dizzy, or feeling like you're about to faint.

          • Although rare, Adempas (riociguat) can cause serious and unusual bleeding (e.g., vomiting blood, bloody nose). Seek medical help if you notice any unusual bleeding or have difficulty stopping a bleed.

            • Adempas (riociguat) can interact with other medications. Make sure to tell your provider about all the medications you're taking, including over-the-counter medications and supplements, before starting Adempas (riociguat). For example, don't take aluminum- or magnesium-containing antacids (e.g., Mylanta (aluminum hydroxide / magnesium hydroxide / simethicone), Rolaids (calcium carbonate / magnesium hydroxide)) within 1 hour of Adempas (riociguat) because they can affect how well Adempas (riociguat) is absorbed into your body. Don't start any new medications while taking Adempas (riociguat) without talking to your provider or pharmacist first.

              • If you're a female who's able to have children, you should use two forms of birth control during treatment with Adempas (riociguat) and for at least 1 month after your last dose. In addition, you'll need to do a pregnancy test every month while you to take Adempas (riociguat). Let your provider know right away if you get pregnant while taking this medication. Adempas (riociguat) can potentially harm an unborn baby.

                • You shouldn't breastfeed during, and for at least 3 days after, treatment with Adempas (riociguat) because it's not known if it's safe for your baby. If stopping breastfeeding isn't an option for you, talk to your provider about switching you to a different medication.

                  • If you miss a dose, skip the missed dose and resume your normal dose at the next scheduled time. Don't double-up the dose to make up for the missed dose. If you miss 3 or more days of Adempas (riociguat), contact your provider to see how you can safely restart the medication.

                    faqs

                    Frequently asked questions about Adempas (riociguat)

                    Is Adempas (riociguat) a blood thinner?
                    No, Adempas (riociguat) isn't a blood thinner (a group of medications that's taken to prevent blood clots). But rather, it's a medication that's taken to lower blood pressure in the vessels of the lungs. Like blood thinners, Adempas (riociguat) does carry a risk for bleeding, but this risk is very low. When you take Adempas (riociguat), look out for symptoms of bleeding (including bleeding inside of your body). If you notice any unusual bleeding (e.g., coughing up or vomiting blood, blood in urine or stool, or bleeding that's difficult to stop), seek medical help right away.
                    How long does it take for Adempas (riociguat) to work?
                    In clinical studies, people taking Adempas (riociguat) started to see improvement within 2 weeks of starting the medication. Specifically, researchers checked for any improvements in how far people were able to walk in 6 minutes, a common test providers use to see if your condition has progressed. Starting week 2, people taking Adempas (riociguat) in both the PAH and CTEPH group were able to walk farther in 6 minutes compared to people who took placebo.
                    How well does Adempas (riociguat) work?
                    In clinical studies, people taking Adempas (riociguat) were able to walk longer distances (118 to 147 feet further) after 3 to 4 months of treatment compared to people who took placebo. Keep in mind that everyone responds differently to Adempas (riociguat). For this reason, your provider will regularly follow up with you to make sure Adempas (riociguat) is helping your condition.
                    Does Adempas (riociguat) cause weight gain?
                    In clinical studies, people didn't report weight gain as a side effect of Adempas (riociguat).
                    What medications should I not take with Adempas (riociguat)?
                    You shouldn't take any nitrates, like nitroglycerin (Nitrostat)), or any medications that raise nitric oxide levels with Adempas (riociguat) because this combination can cause your blood pressure to be dangerously low. In addition, avoid taking Adempas (riociguat) with PDE-5 inhibitors (e.g., sildenafil (Viagra)) at the same time - you must separate them by 24 to 48 hours or else you'll be at risk for dangerously low blood pressure. This isn't a complete list of Adempas (riociguat) and its medication interactions. Make sure to tell your provider and pharmacist about all of the medications you're taking before and during treatment with Adempas (riociguat).
                    Does smoking affect how I take Adempas (riociguat)?
                    Yes. This is because smoking can lower the blood levels of Adempas (riociguat) by about half, so people who smoke might need higher doses of Adempas (riociguat). Make sure to tell your provider if you smoke regularly, or if you decide to start or stop smoking while taking Adempas (riociguat), because your dose will need to be adjusted.
                    What is Adempas (riociguat) REMS?
                    Since Adempas (riociguat) can cause severe and life-threatening harm to babies when taken during pregnancy, the medication is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) for females. The program for this medication is called the Adempas REMS program. All providers who prescribe Adempas (riociguat), pharmacies that dispense Adempas (riociguat), and females who take Adempas (riociguat) must register with the REMS program and follow the requirements in the program. This is to make sure the medication is distributed and taken under the safest conditions possible for you.
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                    warings-icon

                    What are the risks and warnings for Adempas (riociguat)?

                    Adempas (riociguat) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                    risk-warning

                    Not safe to use during pregnancy

                    Adempas (riociguat) shouldn't be taken during pregnancy because it might cause severe and life-threatening harm to unborn babies. Because of this risk, Adempas (riociguat) is available only through the Adempas REMS program. If you're a female who's able to have children, your provider will ask you take a pregnancy test before you start Adempas (riociguat), monthly during treatment, and once more a month after you stop the medication. Females who are able to get pregnant should use two forms of birth control during treatment with Adempas (riociguat) and for at least 1 month after completing treatment. If you're pregnant or thinking of becoming pregnant, talk to your provider about the risks and benefits of using Adempas (riociguat) during pregnancy.

                    risk-warning

                    Low blood pressure

                    • Risk factors: Certain heart problems | Low fluids in the body | Also taking erectile dysfunction medications | Also taking blood pressure-lowering medications

                      Adempas (riociguat) can cause your blood pressure to drop too much, which can make you feel dizzy, tired, or lightheaded. Some medications can interact with Adempas (riociguat), making these effects worse. When you take Adempas (riociguat), make sure to sit down for the first few minutes to avoid dizziness or fainting. Change positions slowly until your body is used to the medication. Get emergency help if you feel like you're going to pass out in addition to having an irregular heartbeat, nausea, vomiting, weakness, changes in vision, sweating, cold and clammy skin, or worse chest pain.

                      risk-warning

                      Bleeding

                      • Risk factors: Taking other medications that raise the risk for bleeding

                        Although rare, Adempas (riociguat) can raise your risk for bleeding. Your risk is higher if you're also taking other medications that can cause bleeding. Tell your provider right away if you notice any abnormal bleeding, see any blood in your stool or urine, or feel more dizzy. Get medical help right away if you have a fall, head injury, or other kinds of physical injury since you might have bleeding inside your body. And contact your provider right away if you have dark or tarry stool or bleeds that are difficult to stop.

                        risk-warning

                        Blockage in the lungs

                        Rarely, fibrous tissue can build up in the small veins of the lungs and lead to a problem called pulmonary veno-occlusive disease, or POVD. Contact your provider if you notice signs of pulmonary edema (e.g., shortness of breath, tiredness, chest pain, sweating, or coughing that doesn't go away) so you can be tested. If you're diagnosed with this rare form of pulmonary hypertension, you'll need to stop Adempas (riociguat).

                        dosage

                        Adempas (riociguat) dosage forms

                        Typical dosing for Adempas (riociguat)

                        The typical starting dose is 0.5 mg to 1 mg by mouth 3 times a day. If needed, your provider will raise your dose every 2 weeks. The maximum dose is 2.5 mg by mouth 3 times a day.

                        Your provider will adjust your dose based on how well it's helping your condition, if you're having side effects, if you're taking a medication that interacts with Adempas (riociguat), and if you smoke.

                        More on Adempas (riociguat) dosage forms

                        adempas: adempas dosage

                        Adempas Dosages: Your GoodRx Guide

                        Written by Austin Ulrich, PharmD, BCACP
                        interactions

                        Interactions between Adempas (riociguat) and other drugs

                        Adempas (riociguat) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Adempas (riociguat). Please note that only the generic name of each medication is listed below.

                        More on Adempas (riociguat) interactions

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                        8 Adempas (Riociguat) Interactions: Paxlovid, Smoking, Viagra, and More

                        Written by Brian Leonard, PharmD, BCACP, BCGP

                        Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                        Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                        contraindications-icon

                        Adempas (riociguat) contraindications

                        Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Adempas (riociguat) will not be safe for you to take.
                        alternatives

                        What are alternatives to Adempas (riociguat)?

                        There are a number of medications that your doctor can prescribe in place of Adempas (riociguat). Compare a few possible alternatives below.
                        Adempas (riociguat)
                        Used for:
                        View Prices
                        Sildenafil (Revatio)
                        Used for:

                        • Pulmonary arterial hypertension (PAH)

                        $9.00 Lowest GoodRx priceView Prices
                        Tadalafil (Adcirca)
                        Used for:

                        • Pulmonary arterial hypertension (PAH)

                        $20.89 Lowest GoodRx priceView Prices

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                        References

                        Best studies we found

                        American Thoracic Society. (2017). Chronic Thromboembolic Pulmonary Hypertension.

                        Bayer HealthCare Pharmaceuticals Inc. (2023). Adempas- riociguat tablet, film coated [package insert]. DailyMed.

                        Bayer. (n.d.). How Adempas works.

                        View All References (11)

                        Bayer. (n.d.). Managing some common side effects of Adempas.

                        Bayer. (n.d.). Welcome to the Adempas REMS (Risk Evaluation and Mitigation Strategy).

                        Bayer. (n.d.). What is Adempas?

                        Demir, R., et al. (2015). Six-minute walk test in pulmonary arterial hypertension. Anatolian Journal of Cardiology.

                        Drugs and Lactation Database (LactMed®). (2021). Riociguat. National Institute of Child Health and Human Development.

                        Frey, R., et al. (2016). Clinical implications of riociguat pharmacokinetics and pharmacodynamics: Introduction to the riociguat clinical pharmacology supplement. Pulmonary Circulation.

                        Lee, J. (2023). Overview of idiopathic interstitial pneumonias. Merck Manual Consumer Version.

                        MedlinePlus. (2015). Pulmonary veno-occlusive disease.

                        National Heart, Lung, and Blood Institute. (2022). Low blood pressure.

                        Sahay, S., et al. (2020). Chronic thromboembolic. CHEST. 

                        Yamamoto, T., et al. (2000). Nitric oxide donors. Proceedings of the Society for Experimental Biology and Medicine.

                        GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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