Soluble Guanylate Cyclase Stimulators

Soluble guanylate cyclase (sGC) stimulators are newer drugs used to treat heart failure (HF). They relax blood vessels and heart muscle cells. This improves blood flow and reduces blood pressure.^1,2

sGC stimulators may reduce hospital stays and prolong life for people with severe HF. They can cause low blood pressure and other side effects. Talk to your doctor about whether sGC stimulators are right for you.^1-3

How do sGC stimulators work?

About 1 in 4 people with HF have low levels of a molecule called cyclic guanosine monophosphate (cGMP). cGMP is a key signaling molecule that protects the heart and blood vessels. It helps relax blood vessels and heart muscle cells. This reduces blood pressure and improves blood flow.^1,4

sGC is an enzyme that makes cGMP. Normally, nitric oxide binds to sGC to activate it. People with HF often have low nitric oxide levels. sGC stimulators activate sGC without nitric oxide. This leads to higher levels of cGMP, which relaxes heart muscle cells and widens blood vessels.^1-4

Examples

As of 2024, the US Food and Drug Administration (FDA) has approved 1 sGC stimulator to treat HF: Verquvo® (vericiguat).²

Verquvo is only meant for adults with severe HF. It is used for adults who:^2,3

• Have symptoms of chronic HF
• Had a recent hospital stay due to HF or need outpatient treatment with intravenous diuretics for HF
• Have reduced ejection fraction (amount of blood pumped with each heartbeat is less than 45 percent)

For these adults, Verquvo may reduce further hospital stays and prolong life. Clinical studies so far have not shown benefits of Verquvo for people with preserved (normal) ejection fraction. Other sGC stimulators may be used to treat other conditions. These have not been shown to work to treat HF.^1,3,4

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. The most common side effects of Verquvo include:^1,2

• Low blood pressure
• Anemia (low red blood cells)

Verquvo has a boxed warning, the strictest warning from the FDA. It has this warning because of the risk of fetal harm and birth defects. Pregnant women should not take Verquvo, and pregnancy should be avoided during treatment and for one month following treatment.²

These are not all the possible side effects of sGC stimulators. Talk to your doctor about what to expect when taking sGC stimulators. You also should call your doctor if you have any changes that concern you when taking sGC stimulators.

Other things to know

Take sGC stimulators as your doctor prescribes. Verquvo is usually taken as an oral tablet once daily with food. Your doctor may adjust your dose over time.^1,2

For people able to become pregnant, your doctor may do a pregnancy test before starting treatment. Your doctor will discuss birth control options to prevent pregnancy during treatment. Tell your doctor right away if you become pregnant or think you are pregnant.²

Before beginning treatment for HF, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs. Other conditions and drugs can affect the risks and benefits of sGC stimulators.²