Cardiovascular, metabolic, and endocrine drugs

Rilmenidine

Rilmenidine (Hyperium) is an imidazoline I1-receptor agonist antihypertensive, 1–2 mg once daily, not available in the US; effective in mild-to-moderate hypertension with less sedation and no rebound than clonidine.

Riociguat

Riociguat (Adempas, BAY 63-2521) is Bayer's oral first-in-class soluble guanylate cyclase stimulator, FDA-approved 2013 for pulmonary arterial hypertension and as the first drug therapy for inoperable or persistent/recurrent CTEPH.

Ritobegron

Ritobegron (KUC-7483), also known as its prodrug ritobegron ethyl, is a selective beta-3 adrenoceptor agonist developed by Kissei Pharmaceutical for overactive bladder; development was discontinued after a failed Phase III trial.

Rivoglitazone

Rivoglitazone (CS-011), a potent PPARγ-agonist thiazolidinedione developed by Daiichi Sankyo for type 2 diabetes; reached phase III with HbA1c reductions superior to pioglitazone but was discontinued in 2009 and never marketed.

Rosuvastatin

Rosuvastatin, sold as Crestor, is a statin drug that blocks HMG-CoA reductase to lower cholesterol, first approved in the United States in 2003 for people at elevated cardiovascular risk.

Sacubitril allisartan calcium tablets

Sacubitril allisartan calcium tablets (沙库巴曲阿利沙坦钙片, 信超妥) are Salubris's ARNI co-crystal of sacubitril and allisartan for primary hypertension; first Chinese-developed ARNI, second globally, approved May 2025, dosed 240 mg once daily.

Saroglitazar

Saroglitazar (Lipaglyn) is a dual PPAR α/γ agonist by Zydus, approved in India in 2013 for diabetic dyslipidemia and in 2020 for NAFLD; not FDA approved, with a PBC NDA under Priority Review.

Satavaptan

Satavaptan (SR 121463, Aquilda) is a Sanofi-developed, highly selective vasopressin V2 receptor antagonist (vaptan class) for hyponatremia and cirrhotic ascites; it raised serum sodium in trials but failed phase III endpoints, showed higher mortality with diuretics, and was withdrawn in 2008, never approved.

Saxagliptin anhydrous

Saxagliptin anhydrous (BMS-477118, CAS 361442-04-8) is the anhydrous form of saxagliptin, a DPP-4 inhibitor for type 2 diabetes marketed as the monohydrate; FDA approved 2009 as Onglyza, with increased heart failure hospitalization risk in SAVOR-TIMI 53.

Selatogrel

Selatogrel (ACT-246475) is an investigational reversible P2Y12 inhibitor given subcutaneously, in Phase 3 (SOS-AMI, NCT04957719) for self-administration at suspected heart attack; developed by Idorsia, now Viatris.

Selexipag

Selexipag (Uptravi, ACT-293987, NS-304) is an oral, non-prostanoid prostacyclin IP receptor agonist prodrug for pulmonary arterial hypertension, hydrolyzed to ACT-333679; approved 2015 after the GRIPHON trial.

Semaglutide

Semaglutide (Ozempic, Wegovy, Rybelsus) is a Novo Nordisk GLP-1 receptor agonist approved since 2017 for type 2 diabetes, obesity, cardiovascular risk reduction, and chronic kidney disease, with oral and injectable forms.

Semuloparin sodium

Semuloparin sodium (AVE5026, Mulsevo) is Sanofi's ultra-low-molecular-weight heparin (2000-3000 Da, anti-Xa:anti-IIa >30:1) for VTE prevention; effective in SAVE-ONCO and hip replacement trials, but its EU application was withdrawn in 2012.

Sepiapterin

Sepiapterin (Sephience, PTC923) is an oral BH4-precursor drug for phenylketonuria, approved in the EU (June 2025) and US (July 2025); it lowers blood phenylalanine more than sapropterin in head-to-head trials.

Seralutinib

Seralutinib (GB002, PK10571) is Gossamer Bio's inhaled tyrosine kinase inhibitor targeting PDGFRα/β, CSF1R, and cKIT for pulmonary arterial hypertension; phase 2 TORREY met its PVR endpoint, phase 3 PROSERA missed its prespecified alpha, and an NDA is planned for September 2026.

Serelaxin

Serelaxin (recombinant human relaxin-2) is an intravenous vasodilatory peptide drug trialed for acute heart failure in the RELAX-AHF and RELAX-AHF-2 trials, with conflicting mortality evidence.

Sermorelin acetate

Sermorelin acetate (Geref), a 29-amino-acid GHRH analogue stimulating pituitary growth hormone release; FDA-approved 1990 and 1997, withdrawn 2009 for commercial reasons, now compounded only.

Setmelanotide

Setmelanotide (IMCIVREE), an MC4R agonist cyclic peptide by Rhythm Pharmaceuticals, treats rare genetic obesity (POMC, PCSK1, LEPR deficiency, Bardet-Biedl syndrome) and acquired hypothalamic obesity via daily subcutaneous injection, first FDA-approved 2020.

Sevelamer

Sevelamer (Renagel, Renvela) is a non-absorbed, calcium-free crosslinked polyallylamine phosphate binder controlling hyperphosphatemia in dialysis patients; hydrochloride salt approved 2000, carbonate 2007, with GI side effects and bile-acid and drug binding.

SGLT2 inhibitor

SGLT2 inhibitors, or gliflozins (canagliflozin, dapagliflozin, empagliflozin), are diabetes drugs that block renal glucose reabsorption, causing glucosuria; developed from phlorizin, they now also treat heart failure and chronic kidney disease.

Shr-4640

Shr-4640 (ruzinaurad, brand Ruiming 瑞鸣) is Hengrui's oral URAT1 inhibitor for gout with hyperuricemia, approved by China's NMPA on May 28, 2026 as the first domestically developed URAT1 inhibitor; phase 3 showed 52.6% vs 34.5% target attainment.

Sildenafil

Sildenafil (Viagra, Revatio) is a Pfizer-developed PDE5 inhibitor, first synthesized as UK-92,480 in 1989 for angina, approved March 27, 1998 as the first oral erectile dysfunction treatment, later repurposed for pulmonary arterial hypertension.

Silodosin

Silodosin (Urief, Rapaflo, Silodyx) is a selective alpha-1A adrenergic receptor antagonist approved for BPH/LUTS, launched in Japan 2006 and FDA-approved 2008; main side effect is abnormal ejaculation, and it outperforms tamsulosin for ureteral stone expulsion.

SILVHIA trial

SILVHIA (Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol), NCT00389168: Swedish double-blind trial in 115 hypertensive patients with LVH; irbesartan reduced left ventricular mass more than atenolol (-26 vs -14 g/m2) despite equal blood pressure control.