{"id":142,"date":"2022-12-01T17:34:25","date_gmt":"2022-12-01T17:34:25","guid":{"rendered":"https:\/\/www.merckconnect.com\/verquvo\/?page_id=142"},"modified":"2025-12-17T15:36:34","modified_gmt":"2025-12-17T15:36:34","slug":"mechanism-of-action","status":"publish","type":"page","link":"https:\/\/www.merckconnect.com\/verquvo\/mechanism-of-action\/","title":{"rendered":"Mechanism of action\/Mechanism of disease"},"content":{"rendered":"<link rel='stylesheet' id='vivid360-spacer-css-css' href='https:\/\/www.merckconnect.com\/verquvo\/wp-content\/themes\/cex-wpvip-mhh-merck-vivid360-theme-1-12\/blocks\/spacer\/css\/style.min.css?ver=1766071753' media='all' \/>\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n\n<link rel='stylesheet' id='vivid360-heading-css-css' href='https:\/\/www.merckconnect.com\/verquvo\/wp-content\/themes\/cex-wpvip-mhh-merck-vivid360-theme-1-12\/blocks\/heading\/css\/style.min.css?ver=1766071753' media='all' \/>\n\n<div class=\"vivid360-heading default-hcp-fontsize default-hcp-tablet-fontsize default-hcp-mobile-fontsize\" id=\"a7ad05e00-f9ef-4002-b1fd-7dd7bfa34fb7\"><h1 class=\"content-width fontWeightRegular\" style=\"--desktopFontSize:var(--h1FontSizeDesktop);--tabletFontSize:var(--h1FontSizeDesktop);--mobileFontSize:var(--h1FontSizeMobile);--desktopLineHeightSize:var(--h1LineHeightDesktop);--tabletLineHeightSize:var(--h1LineHeightDesktop);--mobileLineHeightSize:\" id=\"\"><strong>Mechanism of action \/ Mechanism of disease<\/strong><\/h1><\/div>\n\n\n\n<div style=\"background-color:transparent;height:8px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-8 spacer-undefined\"><\/div>\n\n\n\n<div class=\"vivid360-heading default-hcp-fontsize default-hcp-tablet-fontsize default-hcp-mobile-fontsize\" id=\"a03f9b094-1f2c-4504-a335-a5a7190299f6\"><h2 class=\"content-width fontWeightRegular mb-0\" style=\"--desktopFontSize:var(--h2FontSizeDesktop);--tabletFontSize:var(--h2FontSizeDesktop);--mobileFontSize:var(--h2FontSizeMobile);--desktopLineHeightSize:var(--h2LineHeightDesktop);--tabletLineHeightSize:var(--h2LineHeightDesktop);--mobileLineHeightSize:\" id=\"\"><strong>Discover a different treatment option for your appropriate HFrEF patients<sup>1<\/sup><\/strong><\/h2><\/div>\n\n\n\n<div style=\"background-color:transparent;height:8px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-8 spacer-undefined\"><\/div>\n\n\n\n<p>VERQUVO employs a novel MOA for the treatment of HF, resulting in smooth muscle relaxation and vasodilation.<sup>1<\/sup><\/p>\n\n\n\n<div style=\"background-color:transparent;height:8px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-8 spacer-undefined\"><\/div>\n\n\n\n<p>VERQUVO augments cGMP levels by addressing the impaired NO-sGC-cGMP pathway, which is important in the pathophysiology of HF.<\/p>\n\n\n\n<div style=\"background-color:transparent;height:8px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-8 spacer-undefined\"><\/div>\n\n\n\n\n<link rel='stylesheet' id='vivid360-video-module-css-css' href='https:\/\/www.merckconnect.com\/verquvo\/wp-content\/themes\/cex-wpvip-mhh-merck-vivid360-theme-1-12\/blocks\/video-module\/css\/style.min.css?ver=1766071753' media='all' \/>\n\n<div id=\"\" class=\"wp-block-vivid360-video-module vivid360-block-video-module video-module-center full-page-width\"><div class=\"video-wrapper\"><div data-tracking-video=\"6347239308112\" class=\"vivid360-block-video-module-video-content\"><div><video id=\"video-block\" data-design-category=\"Video\" data-account=\"1905768940001\" data-player=\"default\" data-embed=\"default\" controls data-video-id=\"6347239308112\" data-playlist-id=\"\" data-application-id=\"\" class=\"vjs-fluid video-js\" aria-labelledby=\"video_label\" aria-describedby=\"video_description\"><\/video><\/div><\/div><div id=\"video_label\" hidden>BrightCove Video<\/div><div id=\"video_description\" aria-live=\"polite\" role=\"caption\" hidden><\/div><figure class=\"text-align-left\"><figcaption><\/figcaption><\/figure><\/div><\/div>\n\n\n\n<div style=\"background-color:transparent;height:8px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-8 spacer-undefined\"><\/div>\n\n\n\n<div class=\"vivid360-heading default-hcp-fontsize default-hcp-tablet-fontsize default-hcp-mobile-fontsize\" id=\"a92808f54-f698-44f1-9f85-75b43de11ee9\"><h2 class=\"content-width fontWeightRegular\" style=\"--desktopFontSize:var(--h2FontSizeDesktop);--tabletFontSize:var(--h2FontSizeDesktop);--mobileFontSize:var(--h2FontSizeMobile);--desktopLineHeightSize:var(--h2LineHeightDesktop);--tabletLineHeightSize:var(--h2LineHeightDesktop);--mobileLineHeightSize:\" id=\"\"><strong>Pathophysiology of HF<\/strong><\/h2><\/div>\n\n\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n\n<link rel='stylesheet' id='vivid360-image-module-css-css' href='https:\/\/www.merckconnect.com\/verquvo\/wp-content\/themes\/cex-wpvip-mhh-merck-vivid360-theme-1-12\/blocks\/image-module\/css\/style.min.css?ver=1766071753' media='all' \/>\n\n<div id=\"\" class=\"wp-block-vivid360-image-module ratio-50-50 content-above one-col full-page-width\"><div class=\"vivid360-block-image-module__content-wrapper content-align-left\" id=\"contentDiv\"><\/div><figure class=\"vivid360-block-image-module__image-container\"><picture><source media=\"(max-width: 767px)\" data-srcset=\"https:\/\/www.merckconnect.com\/verquvo\/wp-content\/uploads\/sites\/67\/2025\/04\/Vericiguat_Pathophysiology_2025.png?w=767\"\/><source media=\"(min-width: 768px) and (max-width: 1440px)\" data-srcset=\"https:\/\/www.merckconnect.com\/verquvo\/wp-content\/uploads\/sites\/67\/2025\/04\/Vericiguat_Pathophysiology_2025.png?w=1440\"\/><img decoding=\"async\" data-src=\"https:\/\/www.merckconnect.com\/verquvo\/wp-content\/uploads\/sites\/67\/2025\/04\/Vericiguat_Pathophysiology_2025.png\" src=\"https:\/\/www.merckconnect.com\/verquvo\/wp-content\/uploads\/sites\/67\/2025\/04\/Vericiguat_Pathophysiology_2025.png\" alt=\"Heart Failure is Associated With Low NO bioavailability, Decreased sGC Activity, and Reduced cGMP Synthesis, Leading to Vascular Dysfunction, and Myocardial Dysfunction\"\/><\/picture><figcaption class=\"caption-align-left noCaptionText\" id=\"figcaption\"><p class=\"caption-title vivid360-block-image-module__caption\" style=\"--captionFontSize:14px;--captionFontSizeTablet:14px;--captionFontSizeMobile:14px\"><\/p><\/figcaption><\/figure><\/div>\n\n\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n\n\n<div class=\"vivid360-heading default-hcp-fontsize default-hcp-tablet-fontsize default-hcp-mobile-fontsize\" id=\"a8e3dd964-b337-4ed2-93ab-ca4b6b6d42dd\"><h2 class=\"content-width fontWeightRegular\" style=\"--desktopFontSize:var(--h2FontSizeDesktop);--tabletFontSize:var(--h2FontSizeDesktop);--mobileFontSize:var(--h2FontSizeMobile);--desktopLineHeightSize:var(--h2LineHeightDesktop);--tabletLineHeightSize:var(--h2LineHeightDesktop);--mobileLineHeightSize:\" id=\"\"><strong>Mechanism of Action<\/strong><\/h2><\/div>\n\n\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n\n\n<div id=\"\" class=\"wp-block-vivid360-image-module ratio-50-50 content-above one-col full-page-width\"><div class=\"vivid360-block-image-module__content-wrapper content-align-left\" id=\"contentDiv\"><\/div><figure class=\"vivid360-block-image-module__image-container\"><picture><source media=\"(max-width: 767px)\" data-srcset=\"https:\/\/www.merckconnect.com\/verquvo\/wp-content\/uploads\/sites\/67\/2025\/04\/Vericiguat_MOA_2025.png?w=767\"\/><source media=\"(min-width: 768px) and (max-width: 1440px)\" data-srcset=\"https:\/\/www.merckconnect.com\/verquvo\/wp-content\/uploads\/sites\/67\/2025\/04\/Vericiguat_MOA_2025.png?w=1440\"\/><img decoding=\"async\" data-src=\"https:\/\/www.merckconnect.com\/verquvo\/wp-content\/uploads\/sites\/67\/2025\/04\/Vericiguat_MOA_2025.png\" src=\"https:\/\/www.merckconnect.com\/verquvo\/wp-content\/uploads\/sites\/67\/2025\/04\/Vericiguat_MOA_2025.png\" alt=\"VERQUVO\u00ae (vericiguat) Directly Stimulates the sGC Receptor Through a Binding Site Independent of NO. It Also Increases Sensitivity of sGC to Endogenous NO by Stabilizing the NO Binding Site, Leading to Smooth Muscle Relaxation and Vasodilation, Which May Improve Cardiac Function\"\/><\/picture><figcaption class=\"caption-align-left noCaptionText\" id=\"figcaption\"><p class=\"caption-title vivid360-block-image-module__caption\" style=\"--captionFontSize:14px;--captionFontSizeTablet:14px;--captionFontSizeMobile:14px\"><\/p><\/figcaption><\/figure><\/div>\n\n\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n\n\n<p>cGMP, cyclic guanosine monophosphate; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; MOA, mechanism of action; NO, nitric oxide; sGC, soluble guanylate cyclase<\/p>\n\n\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n\n\n<div class=\"vivid360-heading\" id=\"a100d9d8e-8e91-4c5b-9663-cd76a35c6514\"><h2 class=\"content-width fontWeightRegular mt-0 mb-0\" style=\"--desktopFontSize:16px;--tabletFontSize:16px;--mobileFontSize:16px;--desktopLineHeightSize:24px;--tabletLineHeightSize:24px;--mobileLineHeightSize:\" id=\"\"><strong>References:<\/strong><\/h2><\/div>\n\n\n<link rel='stylesheet' id='vivid360-list-parent-css-css' href='https:\/\/www.merckconnect.com\/verquvo\/wp-content\/themes\/cex-wpvip-mhh-merck-vivid360-theme-1-12\/blocks\/list-parent\/css\/style.css?ver=1766071753' media='all' \/>\n\n<div class=\"vivid-block-list2 content-width  \">\n<ol style=\"--listBulletColor:#333\" class=\"list-bullet-color\">\n<li>Armstrong PW, Pieske B, Anstrom KJ, et al. Vericiguat in patients with heart failure and reduced ejection fraction.<em> N Engl J Med. <\/em>2020;382(20):1883-1893.<\/li>\n\n\n\n<li>Stasch J-P, Pacher P, Evgenov O. Soluble guanylate cyclase as an emerging therapeutic target in cardiopulmonary disease.<em> Circulation.<\/em> 2011;123:2263-2273.<\/li>\n<\/ol>\n<\/div>\n\n\n<link rel='stylesheet' id='vivid360-modal-css-css' href='https:\/\/www.merckconnect.com\/verquvo\/wp-content\/themes\/cex-wpvip-mhh-merck-vivid360-theme-1-12\/blocks\/modal\/css\/style.min.css?ver=1770643873' media='all' \/>\n\n<div class=\"wp-block-vivid360-modal\"><div><div class=\"vivid360-modal-block-container is-style-passive-modal\"><div class=\"vivid360-modal-trigger-container\"><span data-design-module=\"modal\" data-design-category=\"modal-page-load\" class=\"vivid360-modal-trigger-pageload\" data-page-load-parameter=\"safety_overlay\"><\/span><\/div><div class=\"vivid360-modal-container vivid360-modal-blurredBgBlack\"><div class=\"vivid360-modal larger_modal\"><div class=\"vivid360-modal-content-area\"><a class=\"vivid360-modal-close-modal-span\" role=\"button\" aria-description=\"close\" aria-label=\"close\"><i class=\"icon-close\"><\/i><\/a><div class=\"modal-flex-container\"><div class=\"vivid360-modal-label-container  title-left\" style=\"--titleColor:undefined\"><h2><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-primary-color\">Indication<\/mark><\/strong><\/h2><\/div><div class=\"vivid360-modal-content-container has-regular-font-size\">\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n\n<div class=\"vivid360-heading default-hcp-fontsize default-hcp-tablet-fontsize default-hcp-mobile-fontsize\" id=\"a1283bd81-6c07-4ee4-bbb5-8f85e4acc182\"><h2 class=\"content-width fontWeightRegular\" style=\"--desktopFontSize:var(--h2FontSizeDesktop);--tabletFontSize:var(--h2FontSizeDesktop);--mobileFontSize:var(--h2FontSizeMobile);--desktopLineHeightSize:var(--h2LineHeightDesktop);--tabletLineHeightSize:var(--h2LineHeightDesktop);--mobileLineHeightSize:\" id=\"\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-primary-color\">Selected Safety Information<\/mark><\/strong><\/h2><\/div>\n\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n<link rel='stylesheet' id='vivid360-row-module-css-css' href='https:\/\/www.merckconnect.com\/verquvo\/wp-content\/themes\/cex-wpvip-mhh-merck-vivid360-theme-1-12\/blocks\/row\/css\/style.min.css?ver=6.8.5' media='all' \/>\n\n<div style=\"border-width:2px;border-style:solid;border-radius:0;background-color: !important\" class=\"wp-block-vivid360-row vivid360-row hcp-wide-bg-width wide-bg-width\"><div class=\"cropped\" id=\"row5550d302-a838-49ea-9238-f2ca08ada02f\"><div style=\"padding-top:0px;padding-bottom:0px;padding-right:0px;padding-left:4px\" class=\"row-content wide-width hcp-wide-width\">\n\n<div class=\"vivid360-heading\" id=\"aa0c6cd68-0bec-4317-a058-6d521ef919b2\"><h4 class=\"has-text-align-center content-width fontWeightRegular\" style=\"--desktopFontSize:var(--h4FontSizeDesktop);--tabletFontSize:var(--h4FontSizeDesktop);--mobileFontSize:var(--h4FontSizeMobile);--desktopLineHeightSize:var(--h4LineHeightDesktop);--tabletLineHeightSize:var(--h4LineHeightDesktop);--mobileLineHeightSize:;--tabletAlign:center;--mobileAlign:center\" id=\"\"><strong>WARNING: EMBRYO-FETAL TOXICITY<\/strong><\/h4><\/div>\n\n\n<p><strong>Females of reproductive potential: Exclude pregnancy before the start of treatment. To prevent pregnancy, females of reproductive potential must use effective forms of contraception during treatment and for one month after stopping treatment. Do not administer VERQUVO to a pregnant female because it may cause fetal harm.<\/strong><\/p>\n\n<\/div><\/div><\/div>\n\n<link rel='stylesheet' id='vivid360-list-css-css' href='https:\/\/www.merckconnect.com\/verquvo\/wp-content\/themes\/cex-wpvip-mhh-merck-vivid360-theme-1-12\/blocks\/list\/css\/style.min.css?ver=1766071753' media='all' \/>\n\n<div class=\"vivid-block-list content-width  default-list block-eccb4a60-8774-4ffa-a053-e672837ac620 hyperlink-blue\" data-image=\"\" data-image-mobile=\"\" data-image-all=\"\" data-image-all-mobile=\"\" data-icon-color=\"#333\" data-text-color=\"#333\" data-client-id=\"block-eccb4a60-8774-4ffa-a053-e672837ac620\"><ul class=\"first-level\"><li>VERQUVO is contraindicated in patients with concomitant use of other soluble guanylate cyclase (sGC) stimulators.<\/li><li>VERQUVO is contraindicated in pregnancy.<\/li><li><strong>Embryo-Fetal Toxicity:<\/strong>&nbsp;Based on data from animal reproduction studies, VERQUVO may cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential of the potential risk to a fetus. Obtain a pregnancy test before the start of treatment. Advise females of reproductive potential to use effective contraception during treatment with VERQUVO and for at least one month after the final dose.<\/li><li>There is a Pregnancy Surveillance Program that monitors pregnancy outcomes in women exposed to VERQUVO during pregnancy. Health care providers should report any prenatal exposure by calling&nbsp;<span class=\"no-wrap-text\">1-877-888-4231<\/span>&nbsp;or at&nbsp;<a href=\"https:\/\/pregnancyreporting.verquvo-us.com\/\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"interstitial-external-link\">https:\/\/pregnancyreporting.verquvo-us.com<\/span><\/a>.<\/li><li>In a clinical trial, the most commonly observed adverse events with VERQUVO vs placebo, occurring at a frequency \u22655%, were hypotension (16% vs 15%) and anemia (10% vs 7%).<\/li><li>Concomitant use of VERQUVO with PDE-5 inhibitors is not recommended due to the potential for hypotension.<\/li><li>There are no data on the presence of vericiguat in human milk, the effects on the breastfed infant, or effects on milk production. Because of the potential for serious adverse reactions in breastfed infants from VERQUVO, advise women not to breastfeed during treatment with VERQUVO.<\/li><\/ul><\/div>\n\n\n<div style=\"background-color:transparent;height:16px\" class=\"wp-block-vivid360-spacer vivid360-spacer spacer-16\"><\/div>\n\n\n<p><strong>Before prescribing VERQUVO, please read the accompanying <a href=\"https:\/\/www.merck.com\/product\/usa\/pi_circulars\/v\/verquvo\/verquvo_pi.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Prescribing information<\/a> including the Boxed Warning about embryo-fetal toxicity. The <a href=\"https:\/\/www.merck.com\/product\/usa\/pi_circulars\/v\/verquvo\/verquvo_mg.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Medication guide<\/a> also is available.<\/strong><\/p>\n\n<\/div><div class=\"vivid360-modal-button-container desktop-container\"><div class=\"vivid360-button-block\"><a class=\"btn primary primary-regular btn-confirm  vivid360-modal-dismiss-button\" style=\"font-size:14px\" href=\"#!\" title=\"Button 1\" target=\"_self\" rel=\"noopener\" data-design-category=\"button\" data-design-label=\"Button 1\" data-design-module=\"element\">Button 1<\/a><\/div><div class=\"vivid360-button-block\"><a class=\"btn primary primary-regular btn-dismissive  vivid360-modal-dismiss-button\" style=\"font-size:14px\" href=\"#!\" title=\"Button 2\" target=\"_self\" rel=\"noopener\" data-design-category=\"button\" data-design-label=\"Button 2\" data-design-module=\"element\">Button 2<\/a><\/div><\/div><\/div><\/div><div class=\"vivid360-modal-button-container mobile-container \"><div class=\"vivid360-button-block\"><a class=\"btn primary primary-regular btn-confirm  vivid360-modal-dismiss-button\" style=\"font-size:14px\" href=\"#!\" title=\"Button 1\" target=\"_self\" rel=\"noopener\" data-design-category=\"button\" data-design-label=\"Button 1\" data-design-module=\"element\">Button 1<\/a><\/div><div class=\"vivid360-button-block\"><a class=\"btn primary primary-regular btn-dismissive  vivid360-modal-dismiss-button\" style=\"font-size:14px\" href=\"#!\" title=\"Button 2\" target=\"_self\" rel=\"noopener\" data-design-category=\"button\" data-design-label=\"Button 2\" data-design-module=\"element\">Button 2<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>VERQUVO employs a novel MOA for the treatment of HF, resulting in smooth muscle relaxation and vasodilation.1 VERQUVO augments cGMP levels by&#8230;<\/p>\n","protected":false},"author":708,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_trash_the_other_posts":false,"editor_notices":[],"footnotes":""},"ga4_page_audience":[],"ga4_page_birn_id":[],"ga4_page_branding":[272],"ga4_page_businessunit":[],"ga4_page_campaign":[],"ga4_page_content_purpose":[300],"ga4_page_customer_journey_stage":[],"ga4_page_customer_specialty":[335],"ga4_page_experience":[],"ga4_page_indication":[],"ga4_page_material_intent":[484],"ga4_page_product":[626],"ga4_page_region":[711],"ga4_page_therapeuticarea":[],"user_role":[],"mhh-area-of-interest":[],"access":[],"user_status":[],"class_list":["post-142","page","type-page","status-publish"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Mechanism of Action (MOA) of VERQUVO\u00ae (vericiguat)<\/title>\n<meta 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