WRITING “DISPENSE AS WRITTEN” COULD HELP YOUR PATIENTS
REMAIN ON THE BRAND MEDICATION THEY'RE FAMILIAR WITH

For your adult patients with PAH (WHO Group 1) and inoperable or persistent/recurrent
CTEPH (WHO Group 4), treatment continuity is important in maintaining stability.^1,2

Reducing disruptions to your patients' brand of medication can help encourage 
treatment continuity.³ By prescribing Adempas “Dispense As Written,” your patients will
receive the same brand of medication at every refill.⁴

Writing “Dispense As Written” is a legal right in all 50 states that helps to ensure the medication dispensed to a patient at the pharmacy is the brand that was prescribed by the health care provider.

Without “Dispense As Written,” generic substitution can happen without the provider or patient being notified first, meaning a different generic can be dispensed at each refill.

CONSISTENCY IS IMPORTANT IN YOUR PATIENTS'
TREATMENT ROUTINES

WHEN FILLING OUT YOUR PATIENTS’ ADEMPAS PRESCRIPTION AND
PATIENT SUPPORT PROGRAM ENROLLMENT FORM, FILL OUT THE LINE
WHERE IT READS “DISPENSE AS WRITTEN.”

Review your state’s DAW guidance as limitations may apply.

YOUR PATIENTS CAN PLAY A VITAL ROLE IN REMAINING ON THEIR TREATMENT

Encourage your patients to confirm, upon receipt of their prescription, that Adempas has been dispensed as written to ensure they’re receiving the medication they’re familiar with.

Confirm with your patients that they’re familiar with what Adempas medication and packaging looks like to help ensure they’re aware of any substitutions made to their prescription.

PERSONALIZED DOSING FOR YOUR PATIENTS

RECOMMENDED STARTING DOSE⁴

Start with 1 mg taken 3x a day

For patients who may not tolerate the hypotensive effects of Adempas, consider a starting dose of 0.5 mg taken 3x a day.

TITRATION THROUGH MAINTENANCE

Individualized dose adjustments

If systolic blood pressure remains >95 mm Hg and the patient has no signs or symptoms of hypotension, up-titrate the dose by 0.5 mg. Dose increases should be no sooner than 2 weeks apart. The dose can be increased to the highest tolerated dosage, up to a maximum of 2.5 mg taken 3x a day.⁴

If at any time the patient has symptoms of hypotension, decrease the dosage by 0.5 mg.⁴

AN ALTERNATIVE FOR PATIENTS
WHO ARE UNABLE TO SWALLOW WHOLE TABLETS

Adempas may be crushed and mixed with water or soft foods (such as applesauce) immediately before administration.⁴

Crushed and mixed with water

Crushed and mixed with soft foods (such as applesauce)

TRANSITION FROM OR TO ADEMPAS

Clock showing 3 o’clock with a red and gray pill, representing dosing schedule and medication timing

TRANSITIONING TO ADEMPAS FROM SILDENAFIL OR TADALAFIL?

Before administering Adempas⁴:

Discontinue sildenafil for at least 24 hours
Discontinue tadalafil for at least 48 hours
- Consider initiating Adempas at a starting dose of 0.5 mg in patients at risk of hypotension
- Monitor for signs and symptoms of hypotension on initiation

Clock showing 9 o’clock with a red and gray pill, representing dosing schedule and medication timing

TRANSITIONING TO A PDE-5 INHIBITOR FROM ADEMPAS?

Before administering a PDE-5 inhibitor⁴:

Discontinue Adempas for at least 24 hours
- Monitor for signs and symptoms of hypotension on initiation and on treatment with strong CYP and P-gp/BCRP inhibitors

CYP=cytochrome P450; PDE-5=phosphodiesterase type 5; P-gp/BCRP=P-glycoprotein/breast cancer resistance protein

DOSAGE CONSIDERATIONS⁴

Dosage interruption

If a dose is missed, advise patients to continue with the next regularly scheduled dose
In case Adempas is interrupted for 3 days or more, re-titrate Adempas

Pregnancy testing in females of reproductive potential

Exclude pregnancy prior to initiation of treatment with Adempas. Advise females of reproductive potential to use effective contraception prior to initiation of treatment, during treatment with Adempas and for at least one month after the last dose. When pregnancy is detected, discontinue Adempas as soon as possible.

Use in patients who smoke

Consider titrating to dosages higher than 2.5 mg 3x a day, if tolerated, in patients who smoke
A dose decrease may be required in patients who stop smoking

Strong CYP and P-gp/BCRP inhibitors

Consider a starting dose of 0.5 mg, 3x a day when initiating Adempas in patients receiving strong CYP and P-gp/BCRP inhibitors such as azole antimycotics (for example, ketoconazole and itraconazole) or HIV protease inhibitors (such as ritonavir)
Monitor for signs and symptoms of hypotension on initiation and on treatment with strong CYP and P-gp/BCRP inhibitors

DOWNLOAD THE DOSING + ADMINISTRATION GUIDE

Potential drug interactions to consider when prescribing Adempas

	Interaction Type	Clinical Considerations
PHARMACODYNAMIC INTERACTIONS	Nitrates	Co-administration of Adempas with nitrates or nitric oxide donors (such as amyl nitrite) in any form is contraindicated because of hypotension.
PHARMACODYNAMIC INTERACTIONS	PDE Inhibitors	Co-administration of Adempas with specific PDE5 inhibitors (such as sildenafil, tadalafil, or vardenafil) and nonspecific PDE inhibitors (such as dipyridamole or theophylline) is contraindicated because of hypotension. Co-administration with other phosphodiesterase inhibitors (such as milrinone, cilostazole, roflumilast) is labelled. To transition patients to and from a PDE5 inhibitor to Adempas, follow the titration information in the Dosing and Administration Guide.
PHARMACOKINETIC INTERACTIONS CONSIDERATIONS	If your patient is a smoker	Plasma concentrations in smokers are reduced by 50% to 60% compared to nonsmokers. Doses higher than 2.5 mg 3x a day may be considered to match exposure seen in nonsmoking patients.
	If your patient takes strong CYP AND P-gp/BCR inhibitors	A dose reduction should be considered in patients who stop smoking. Concomitant use of riociguat with strong cytochrome CYP inhibitors and P-gp/BCRP inhibitors such as azole antimycotics (for example, ketoconazole, itraconazole) or HIV protease inhibitors (such as ritonavir) increase riociguat exposure and may result in hypotension. Consider a starting dose of 0.5 mg 3x a day when initiating Adempas in patients on induction and on treatment with strong CYP and P-gp/BCRP inhibitors. Monitor for signs and symptoms of hypotension on initiation and on treatment with strong CYP and P-gp/BCRP inhibitors.
	If your patient takes strong CYP3A Inducers	A dose reduction should not be considered in patients who do not tolerate the hypotensive effect of riociguat. Strong inducers of CYP3A (such as rifampicin, carbamazepine, phenobarbital, or St. John's Wort) may significantly reduce riociguat exposure. No clinical data is available to guide dosing of riociguat when strong CYP3A inducers are co-administered.
	If your patient takes antacids	Antacids such as aluminum hydroxide/magnesium hydroxide decrease riociguat absorption and should not be taken within 1 hour of taking Adempas.

Potential drug interactions to consider when prescribing Adempas

PHARMACODYNAMIC INTERACTIONS

Nitrates

Co-administration of Adempas with nitrates or nitric oxide donors (such as amyl nitrite) in any form is contraindicated because of hypotension.

PDE Inhibitors

Co-administration of Adempas with specific PDE5 inhibitors (such as sildenafil, tadalafil, or vardenafil) and nonspecific PDE inhibitors (such as dipyridamole or theophylline) is contraindicated because of hypotension. Co-administration with other phosphodiesterase inhibitors (such as milrinone, cilostazole, roflumilast) is labelled.

To transition patients to and from a PDE5 inhibitor to Adempas, follow the titration information in the Dosing and Administration Guide.

PHARMACOKINETIC INTERACTIONS CONSIDERATIONS

If your patient is a smoker

Plasma concentrations in smokers are reduced by 50% to 60% compared to nonsmokers.

Doses higher than 2.5 mg 3x a day may be considered to match exposure seen in nonsmoking patients.

If your patient takes strong CYP AND P-gp/BCR inhibitors

A dose reduction should be considered in patients who stop smoking.

Concomitant use of riociguat with strong cytochrome CYP inhibitors and P-gp/BCRP inhibitors such as azole antimycotics (for example, ketoconazole, itraconazole) or HIV protease inhibitors (such as ritonavir) increase riociguat exposure and may result in hypotension.

Consider a starting dose of 0.5 mg 3x a day when initiating Adempas in patients on induction and on treatment with strong CYP and P-gp/BCRP inhibitors.

Monitor for signs and symptoms of hypotension on initiation and on treatment with strong CYP and P-gp/ BCRP inhibitors.

If your patient takes strong CYP3A Inducers

A dose reduction should not be considered in patients who do not tolerate the hypotensive effect of riociguat.

Strong inducers of CYP3A (such as rifampicin, carbamazepine, phenobarbital, or St. John's Wort) may significantly reduce riociguat exposure. No clinical data is available to guide dosing of riociguat when strong CYP3A inducers are co-administered.

If your patient takes antacids

Antacids such as aluminum hydroxide/magnesium hydroxide decrease riociguat absorption and should not be taken within 1 hour of taking Adempas.

PERSONALIZED PATIENT SUPPORT

FROM INITIATION THROUGH TITRATION, THE AIM PATIENT SUPPORT PROGRAM OFFERS NURSING SUPPORT FOR YOUR PATIENTS EVERY STEP OF THE WAY

PATIENT DIAGNOSIS

NURSE INITIATES STARTING DOSE

ASSESS

NURSE FOLLOW UP VISITS

Nurse visits continue to review titration progress in consultation with the HCP and follow up on the patient’s specific needs

MORE IMPORTANT SAFETY INFORMATION LESS IMPORTANT SAFETY INFORMATION

Important Safety Information and Indications

WARNING: EMBRYO-FETAL TOXICITY

Adempas is contraindicated for use during pregnancy because it may cause fetal harm based on animal data.

Exclude pregnancy prior to the start of treatment with Adempas. Advise use of effective contraception prior to initiation of treatment, during treatment, and for one month after treatment with Adempas.

If pregnancy is detected, discontinue Adempas as soon as possible.

Contraindications

Use of Adempas is contraindicated in patients who are pregnant.
Co-administration of Adempas with nitrates or nitric oxide donors (such as amyl nitrite) in any form is contraindicated.
Concomitant administration of Adempas with specific phosphodiesterase (PDE)-5 inhibitors (such as sildenafil, tadalafil, or vardenafil) or nonspecific PDE inhibitors (such as dipyridamole or theophylline) is contraindicated. Do not administer within 24 hours of sildenafil. Do not administer 24 hours before or within 48 hours after tadalafil.
Adempas is contraindicated in patients with concomitant use of other soluble guanylate cyclase (sGC) stimulators.
Adempas in contraindicated in patients with Pulmonary Hypertension associated with Idiopathic Interstitial Pneumonias (PH-IIP).

Warnings and Precautions

Embryo-Fetal Toxicity. Based on data from animal reproduction studies, Adempas may cause fetal harm when administered to a pregnant patient and is contraindicated during pregnancy. The available human data for riociguat do not establish the presence or absence of major birth defects related to the use of Adempas. Counsel patients who can become pregnant on the potential risk to a fetus. Exclude pregnancy prior to initiation of treatment with Adempas. Advise females of reproductive potential to use effective contraception prior to initiation of treatment, during treatment with Adempas and for at least one month after the last dose. When pregnancy is detected, discontinue Adempas as soon as possible.

Hypotension. Adempas reduces blood pressure. Consider the potential for symptomatic hypotension or ischemia in patients with hypovolemia, severe left ventricular outflow obstruction, resting hypotension, autonomic dysfunction, or concomitant treatment with antihypertensives or strong CYP and P-gp/BCRP inhibitors. Consider a dose reduction if patient develops signs or symptoms of hypotension.

Bleeding. In the placebo-controlled clinical trials, serious bleeding occurred in 2.4% of patients taking Adempas compared to 0% of placebo patients. Serious hemoptysis occurred in 5 (1%) patients taking Adempas compared to 0 placebo patients, including one event with fatal outcome. Serious hemorrhagic events also included 2 patients with vaginal hemorrhage, 2 with catheter-site hemorrhage, and 1 each with subdural hematoma, hematemesis, and intra-abdominal hemorrhage.

Pulmonary Veno-Occlusive Disease. Pulmonary vasodilators may significantly worsen the cardiovascular status of patients with pulmonary veno-occlusive disease (PVOD). Therefore, administration of Adempas to such patients is not recommended. Should signs of pulmonary edema occur, the possibility of associated PVOD should be considered and if confirmed, discontinue treatment with Adempas.

Most Common Adverse Reactions

The most common adverse reactions occurring more frequently (≥3%) on Adempas than placebo were headache (27% vs 18%), dyspepsia/gastritis (21% vs 8%), dizziness (20% vs 13%), nausea (14% vs 11%), diarrhea (12% vs 8%), hypotension (10% vs 4%), vomiting (10% vs 7%), anemia (7% vs 2%), gastroesophageal reflux disease (5% vs 2%), and constipation (5% vs 1%).

Other events that were seen more frequently in Adempas compared to placebo and potentially related to treatment were palpitations, nasal congestion, epistaxis, dysphagia, abdominal distension, and peripheral edema.

Indications

Adempas (riociguat) is indicated for the treatment of adults with persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) (WHO Group 4) after surgical treatment or inoperable CTEPH to improve exercise capacity and WHO functional class.
Adempas is indicated for the treatment of adults with pulmonary arterial hypertension (PAH) (WHO Group 1) to improve exercise capacity, improve WHO functional class and to delay clinical worsening.*

Efficacy was shown in patients on Adempas monotherapy or in combination with endothelin receptor antagonists or prostanoids. Studies establishing effectiveness included predominantly patients with WHO functional class II–III and etiologies of idiopathic or heritable PAH (61%) or PAH associated with connective tissue diseases (25%).

^*Time to clinical worsening was a combined endpoint defined as death (all-cause mortality), heart/lung transplantation, atrial septostomy, hospitalization due to persistent worsening of pulmonary hypertension, start of new PAH-specific treatment, persistent decrease in 6MWD, and persistent worsening of WHO functional class.

For important risk and use information, please see the full Prescribing Information, including Boxed Warning.

References:

Ahern BJ, Fulford ST, Long D, Miller CL. Pulmonary Arterial Hypertension: Recognition and Management in Primary and Acute Care Settings. Cureus. 2025;17(12):e100073. Published online December 25, 2025. doi:10.7759/cureus.100073
Simeone B, Maggio E, Schirone L, et al. Chronic Thromboembolic Pulmonary Hypertension: the therapeutic assessment. Front Cardiovasc Med. 2024;11:1439411. Published online July 25, 2024. doi:10.3389/fcvm.2024.1439411
Straka RJ, Keohane DJ, Liu LZ. Potential Clinical and Economic Impact of Switching Branded Medications to Generics. Am J Ther. 2017;24(3):e278-e289. doi:10.1097/MJT.0000000000000282
Adempas Prescribing Information. Whippany, NJ. Bayer Pharmaceuticals Inc., 2026.

PRESCRIBING ADEMPAS

Keeping your patients on Adempas

WRITING “DISPENSE AS WRITTEN” COULD HELP YOUR PATIENTS
REMAIN ON THE BRAND MEDICATION THEY'RE FAMILIAR WITH

CONSISTENCY IS IMPORTANT IN YOUR PATIENTS'
TREATMENT ROUTINES

YOUR PATIENTS CAN PLAY A VITAL ROLE IN REMAINING ON THEIR TREATMENT

WARNING: EMBRYO-FETAL TOXICITY

PRESCRIBING ADEMPAS

Keeping your patients on Adempas

WRITING “DISPENSE AS WRITTEN” COULD HELP YOUR PATIENTS REMAIN ON THE BRAND MEDICATION THEY'RE FAMILIAR WITH

CONSISTENCY IS IMPORTANT IN YOUR PATIENTS' TREATMENT ROUTINES

YOUR PATIENTS CAN PLAY A VITAL ROLE IN REMAINING ON THEIR TREATMENT

WARNING: EMBRYO-FETAL TOXICITY

WRITING “DISPENSE AS WRITTEN” COULD HELP YOUR PATIENTS
REMAIN ON THE BRAND MEDICATION THEY'RE FAMILIAR WITH

CONSISTENCY IS IMPORTANT IN YOUR PATIENTS'
TREATMENT ROUTINES