Everything you need to know about Adempas (Riociguat) in 2026: what it treats, how it's dosed, who shouldn't take it, and what it costs.
Adempas is a prescription medication used to treat two serious forms of pulmonary hypertension — a condition where the blood pressure in the arteries of the lungs is dangerously high. If you or someone you care about has been prescribed Adempas, or if you're researching it after a new diagnosis, this guide covers everything you need to know in plain language.
Adempas is the brand name for Riociguat, a medication manufactured by Bayer. It belongs to a drug class called soluble guanylate cyclase (sGC) stimulators — and it's the only FDA-approved drug in this class.
In simple terms, Adempas works by stimulating an enzyme in your blood vessel walls that helps them relax and widen. When the blood vessels in your lungs relax, blood flows through them more easily, which lowers the pressure on your heart and improves your ability to be active. For a deeper look at how this works, see our guide on how Adempas works.
Adempas was first approved by the FDA in October 2013 and has been used to treat thousands of patients worldwide.
Adempas is FDA-approved for two conditions:
CTEPH is a form of pulmonary hypertension caused by blood clots in the lungs that don't fully dissolve. These clots block or narrow the pulmonary arteries, forcing the heart to work harder. Adempas is the only FDA-approved medication for CTEPH — specifically for:
This makes Adempas uniquely important for CTEPH patients who have limited treatment options.
PAH is a progressive condition where the small arteries in the lungs become narrowed, stiff, or blocked. This increases the pressure in the lungs and strains the right side of the heart. Adempas is approved for PAH (WHO Group 1) to improve exercise capacity and slow clinical worsening.
For PAH, Adempas is one of several treatment options. Others include endothelin receptor antagonists like Bosentan (Tracleer), Ambrisentan (Letairis), and Macitentan (Opsumit), as well as prostacyclin pathway therapies like Treprostinil and Selexipag (Uptravi). See our full comparison of alternatives to Adempas.
Adempas comes as a tablet taken by mouth three times daily — roughly every 8 hours. Here's what the dosing schedule typically looks like:
Most patients start at 1 mg three times daily. If your systolic blood pressure is already low (or you're at risk for low blood pressure), your doctor may start at 0.5 mg three times daily.
Your doctor will gradually increase your dose every 2 weeks based on how your blood pressure responds and how well you tolerate the medication. The goal is to reach the highest dose you can handle without excessive side effects.
The typical titration looks like:
The target maintenance dose is 2.5 mg three times daily. However, some patients may need a lower maintenance dose (as low as 0.5 mg three times daily) if they can't tolerate the higher doses.
Adempas is not safe for everyone. The following are absolute contraindications — meaning you should never take Adempas if any of these apply:
Adempas carries an FDA boxed warning (the most serious type of warning) for embryo-fetal toxicity. It can cause severe birth defects and fetal death. Women who are pregnant must not take Adempas. Women who could become pregnant must:
This is enforced through the Adempas REMS program, which is the reason the medication has restricted distribution.
Adempas must never be taken with nitrates (such as nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate) or nitric oxide donors. The combination can cause a dangerous, life-threatening drop in blood pressure.
Adempas is contraindicated with PDE-5 inhibitors including Sildenafil (Viagra, Revatio), Tadalafil (Cialis, Adcirca), and Vardenafil (Levitra). These medications work on a similar pathway, and combining them with Adempas can cause severe hypotension. Learn more about Adempas drug interactions.
Patients with PVOD should not take Adempas, as it may worsen their condition and cause pulmonary edema (fluid in the lungs).
The most common side effects of Adempas include headache, dizziness, nausea, diarrhea, low blood pressure, vomiting, indigestion, and anemia. Most of these are manageable and often improve over time. Serious side effects include dangerously low blood pressure and bleeding (including rare cases of pulmonary hemorrhage).
For a detailed breakdown, read our guide on Adempas side effects.
Adempas is one of the most expensive oral medications available:
There is no commercially available generic. While a generic Riociguat was FDA-approved in September 2022 (by MSN Laboratories), active patents prevent it from being sold until at least February 2034.
However, most patients don't pay the list price. Bayer's Aim Co-Pay Assistance Program can reduce copays to as low as $0 for commercially insured patients. Uninsured patients may qualify for free medication through the Bayer US Patient Assistance Foundation. See our complete guide on how to save money on Adempas.
Adempas is a critical medication for patients with PAH and CTEPH — especially for CTEPH patients, where it's the only FDA-approved drug option. It's effective, but it comes with important safety considerations: the pregnancy contraindication, drug interactions with nitrates and PDE-5 inhibitors, and the need for careful dose titration.
If you've been prescribed Adempas, work closely with your PH specialist through the titration process, enroll in the Aim support program for cost assistance, and don't hesitate to reach out if you have questions.
Need help finding Adempas? Medfinder can help you locate pharmacies with it in stock. Looking for a specialist? Our guide on finding a doctor who prescribes Adempas walks you through the process.
You focus on staying healthy. We'll handle the rest.
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