Chronic thromboembolic pulmonary hypertension (CTEPH)

Active Ingredient: Riociguat

Indication for Riociguat

Population group: only adults (18 years old or older)

Riociguat is indicated for the treatment of adult patients with WHO Functional Class (FC) II to III with:

  • inoperable CTEPH,
  • persistent or recurrent CTEPH after surgical treatment, to improve exercise capacity.

For this indication, competent medicine agencies globally authorize below treatments:

3.0-7.5 mg in 3 divided doses daily

Route of admnistration

Oral

Defined daily dose

3 - 7.5 mg

Dosage regimen

From 1 To 2.5 mg 3 time(s) per day every day

Loading dose

3 mg

Detailed description

Dose titration

The recommended starting dose is 1 mg three times daily for 2 weeks. Tablets should be taken three times daily approximately 6 to 8 hours apart.

Dose should be increased by 0.5 mg three times daily every two weeks to a maximum of 2.5 mg three times daily, if systolic blood pressure is ≥95 mmHg and the patient has no signs or symptoms of hypotension. In some PAH patients, an adequate response on the 6-minute walk distance (6MWD) may be reached at a dose of 1.5 mg three times a day. If systolic blood pressure falls below 95 mmHg, the dose should be maintained provided the patient does not show any signs or symptoms of hypotension. If at any time during the up-titration phase systolic blood pressure decreases below 95 mmHg and the patient shows signs or symptoms of hypotension the current dose should be decreased by 0.5 mg three times daily.

Maintenance dose

The established individual dose should be maintained unless signs and symptoms of hypotension occur. The maximum total daily dose is 7.5 mg i.e., 2.5 mg 3 times daily. If a dose is missed, treatment should be continued with the next dose as planned. If not tolerated, dose reduction should be considered at any time.

Food

Tablets can generally be taken with or without food. For patients prone to hypotension, as a precautionary measure, switches between fed and fasted riociguat intake are not recommended because of increased peak plasma levels of riociguat in the fasting compared to the fed state.

Treatment discontinuation

In case treatment has to be interrupted for 3 days or more, treatment should be restarted with 1 mg three times daily for 2 weeks, and continued with the dose titration regimen as described above.

Dosage considerations

It can generally be taken with or without food.

Active ingredient

Riociguat

Riociguat is a stimulator of soluble guanylate cyclase (sGC), an enzyme in the cardiopulmonary system and the receptor for nitric oxide (NO). Riociguat restores the NO-sGC-cGMP pathway and leads to increased generation of cGMP.

Read more about Riociguat

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