Riociguat Tablets (Adempas) demonstrate significant value in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH). As a targeted therapeutic drug, its unique pharmacological mechanism delivers favorable efficacy while also being accompanied by a series of safety concerns that require special attention.

What Are the Side Effects of Riociguat Tablets (Adempas)?

Systemic Reactions

Headache: Incidence rate of 27%.

Dizziness: Incidence rate of 20%.

Gastrointestinal Reactions

Dyspepsia and gastritis: Incidence rate of 21%.

Nausea: Incidence rate of 14%.

Diarrhea: Incidence rate of 12%.

Vomiting: Incidence rate of 10%.

Gastroesophageal reflux disease: Incidence rate of 5%.

Constipation: Incidence rate of 5%.

Severe Side Effects of Riociguat Tablets (Adempas) That Require Alertness

Embryo-Fetal Toxicity

Contraindicated in pregnant women, as it may cause fetal harm.

Teratogenic effects were observed in animal studies; abnormalities occurred when the exposure dose was only a few times the maximum recommended human dose.

Bleeding Risk

The incidence of severe bleeding events in clinical trials was 2.4%.

The incidence of hemoptysis reached 1%, and there have been reports of fatal cases.

Other bleeding events include vaginal bleeding, catheter site bleeding, subdural hematoma, etc.

Symptomatic Hypotension

The drug can lower blood pressure, and the risk is higher in patients with hypovolemia, left ventricular outflow tract obstruction, or autonomic nervous system dysfunction.

Exacerbation of Pulmonary Venous Occlusive Disease (PVOD)

Pulmonary vasodilators may significantly worsen the cardiovascular status of patients with PVOD.

If signs of pulmonary edema appear, the possibility of PVOD should be considered and the drug should be discontinued promptly.

Precautions for Administration of Riociguat Tablets (Adempas)

Management of Drug Interactions

Strong CYP and P-gp/BCRP inhibitors: Such as ketoconazole, itraconazole, or HIV protease inhibitors.

It is recommended to start with an initial dose of 0.5 mg, three times a day.

Signs and symptoms of hypotension need to be monitored.

Antacids: The interval between administrations should be at least 1 hour.

Management of Special Physiological States

Smoking patients: A dose higher than 2.5 mg three times a day may be required (if tolerated).

Dose reduction should be considered after smoking cessation.

Protection Against Embryo-Fetal Toxicity

Women of childbearing age need monthly pregnancy testing.

Effective contraceptive measures must be taken during treatment and for 1 month after discontinuing the drug.