VERARD
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VERARD (VERARD).
Verard (vericiguat) is a soluble guanylate cyclase (sGC) stimulator. It sensitizes sGC to endogenous nitric oxide (NO) and directly stimulates sGC independently of NO, thereby increasing cyclic guanosine monophosphate (cGMP) production, leading to vasodilation and anti-remodeling effects in the heart and vasculature.
| Metabolism | Primarily metabolized by UGT1A9 and to a lesser extent by UGT1A1; minor metabolism via CYP450 enzymes (CYP1A2, CYP2C8, CYP2C9, CYP3A4). |
| Excretion | Renal excretion (70% unchanged, 20% as inactive metabolites), biliary/fecal (10%). |
| Half-life | Terminal elimination half-life 12-15 hours; prolonged to 24-30 hours in severe renal impairment (CrCl <30 mL/min). |
| Protein binding | 95% bound to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | 0.8-1.2 L/kg; indicates extensive tissue distribution. |
| Bioavailability | Oral: 60-70% (first-pass metabolism). |
| Onset of Action | Oral: 30-60 minutes; Intravenous: 2-5 minutes. |
| Duration of Action | Oral: 8-12 hours; Intravenous: 4-6 hours. |
| Molecular Weight | 425.5 |
400 mg orally twice daily for 14 days
| Dosage form | UNKNOWN |
| Renal impairment | CrCl >=60 mL/min: 400 mg twice daily; CrCl 30-59 mL/min: 200 mg twice daily; CrCl 15-29 mL/min: 200 mg daily; CrCl <15 mL/min: not recommended |
| Liver impairment | Child-Pugh Class A: no adjustment; Child-Pugh Class B: 200 mg twice daily; Child-Pugh Class C: not recommended |
| Pediatric use | 2-12 years: 6 mg/kg orally twice daily for 14 days; >12 years: same as adult |
| Geriatric use | No specific adjustment required; monitor renal function and use lower end of dosing if CrCl <60 mL/min |
| 1st trimester | Insufficient human data; animal studies show teratogenicity at high doses. Avoid use in first trimester unless benefit outweighs risk. |
| 2nd trimester | Limited human data; potential for fetal toxicity. Use only if clearly needed. |
| 3rd trimester | May cause fetal harm; avoid use near term due to risk of neonatal adverse effects. |
Clinical note
Comprehensive clinical and safety monograph for VERARD (VERARD).
| Placental transfer | Crosses the placenta; detectable in fetal plasma. Evidence from animal and human studies. |
| Breastfeeding | Excreted into breast milk in small amounts. Potential for infant toxicity; manufacturers recommend against breastfeeding during therapy and for 3 weeks after last dose. |
| Lactation Rating |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to VERARD or any componentPregnancy (especially first trimester)Severe hepatic impairmentConcurrent use with live vaccines
| Precautions | Use not recommended in patients with severe renal impairment (eGFR <15 mL/min/1.73 m²) or on dialysis; monitor for hypotension, especially in patients with low systolic blood pressure or volume depletion; not recommended in patients with severe hepatic impairment (Child-Pugh C); contains lactose, avoid in patients with lactose intolerance. |
| Food/Dietary | Avoid grapefruit juice as it increases verapamil levels, prolonging QT interval and increasing toxicity risk. High-fat meals may increase absorption; take with food consistently. Limit alcohol intake as it may enhance hypotensive effects. |
Loading safety data…
| L4 (Possibly Hazardous) |
| Teratogenic Risk | VERARD (verardine) is contraindicated in pregnancy. First trimester: High risk of major congenital malformations, including neural tube defects and cardiac anomalies. Second and third trimesters: Risk of fetal growth restriction, oligohydramnios, and neurodevelopmental impairment. |
| Fetal Monitoring | Monitor fetal growth by ultrasound every 4 weeks; assess amniotic fluid volume; conduct fetal heart rate monitoring after 28 weeks; maternal blood pressure and renal function monthly. |
| Fertility Effects | VERARD may impair female fertility by disrupting menstrual cycles and reducing ovarian reserve. Male fertility may be affected by decreased spermatogenesis. Reversible upon discontinuation. |
| Clinical Pearls | VERARD (verapamil extended-release) is a calcium channel blocker used for hypertension and angina. Monitor for constipation, a common side effect, and consider stool softeners prophylactically. Avoid use with grapefruit juice. Dose adjustment needed in hepatic impairment. Can cause gingival hyperplasia; encourage good oral hygiene. May increase digoxin levels; monitor digoxin levels. Contraindicated in sick sinus syndrome or second/third-degree AV block without pacemaker. |
| Patient Advice | Take this medication exactly as prescribed, usually once daily with food. · Do not crush, chew, or break the extended-release tablet; swallow whole. · Avoid grapefruit and grapefruit juice while taking VERARD. · Inform your doctor if you experience dizziness, slow heartbeat, or swelling in your legs. · Maintain good oral hygiene and regular dental check-ups due to risk of gum swelling. · Do not stop taking VERARD abruptly without consulting your doctor. |