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**Frespaciguat** (MK-5475) is an investigational, inhaled **small molecule** drug developed as a **soluble guanylate cyclase (sGC) stimulator**. Its mechanism enhances cGMP production in pulmonary vascular smooth muscle, which helps relax blood vessels and reduce pulmonary vascular resistance. It is hypothesized to minimize the systemic side effects often seen with oral or intravenous vasodilators by providing targeted delivery to the lungs via inhalation. Frespaciguat is being developed for the treatment of various forms of **pulmonary hypertension**, including idiopathic, heritable, drug/toxin-induced, pulmonary hypertension due to connective tissue or congenital heart disease, and pulmonary hypertension associated with chronic obstructive pulmonary disease (PH-COPD). Clinical trials are mainly in the **Phase 2/3** stage, testing its effect on 6-minute walk distance and pulmonary vascular resistance.
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