Q: How Guanylate cyclase (sGC)stimulant (Riociguat) (trade name = Adempas) works for thromboembolic Pulmonary hypertension? 


Answer: It has a dual mode of action.

1. Increases the sensitivity of sGC to endogenous nitric oxide (NO)
2. Directly stimulate the receptor to mimic the action of NO

It should be used with extreme caution in patients who are already on nitrates and phosphodiesterase inhibitors.


References: 

1. Rubin LJ, Galiè N, Grimminger F, et al. Riociguat for the treatment of pulmonary arterial hypertension: a long-term extension study (PATENT-2). - Eur Respir J 2015; 45:1303. 

2. Ghofrani HA, Galiè N, Grimminger F, et al. Riociguat for the treatment of pulmonary arterial hypertension. N Engl J Med 2013; 369:330.