Riociguat: Uses, Interactions and Safety
Uses
Riociguat stimulates soluble guanylate cyclase, helping pulmonary blood vessels relax. It is used for selected pulmonary arterial hypertension (PAH) and for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), or persistent/recurrent CTEPH after surgery. Operability must be assessed by an expert team because surgery may be curative for suitable patients.
Administration
Tablets are taken by mouth on a specialist schedule. The dose is adjusted according to blood pressure and tolerability. Do not switch between riociguat and a PDE5 inhibitor without a supervised interval and transition plan. Starting or stopping smoking can substantially alter exposure and should be reported.
Safety
Low blood pressure and serious respiratory bleeding are important risks. Fainting, coughing blood or sudden worsening breathlessness require urgent care. Severe liver impairment, very low starting blood pressure and pulmonary hypertension associated with idiopathic interstitial pneumonia are restrictions. Pulmonary oedema may suggest an underlying veno-occlusive disorder.
Interactions
Nitrates, nitric-oxide donors, PDE5 inhibitors such as sildenafil or tadalafil, and another guanylate-cyclase stimulator must not be combined. Some systemic antifungals and ritonavir-containing treatments increase exposure and need specialist assessment. Enzyme inducers may reduce effectiveness. Antacids can reduce absorption and require separation according to the relevant product instructions. Bosentan can be part of PAH treatment but changes riociguat exposure.
Pregnancy and breastfeeding
Pregnancy is contraindicated. Effective contraception and monthly pregnancy testing are recommended. Breastfeeding should be discontinued during treatment because infant risk cannot be excluded.
Adverse effects
Headache, dizziness, indigestion, nausea, diarrhoea, low blood pressure and swelling are common. Blood-pressure symptoms deserve particular attention when another medicine is started or stopped. This entry focuses on adult tablet use; international paediatric authorisations do not establish a Turkish paediatric indication.
Sources
- Adempas Summary of Product Characteristics
- ADEMPAS 1 mg Turkish product information
- Adempas Summary of Product Characteristics
- FDA examples of drugs that interact with CYP enzymes and transporter systems
- Stendra (avanafil) US Prescribing Information
Additional verified references
The linked Turkish profile contains the medicine record and its documented interaction list.