Drug interactions
Apalutamide + Riociguat
Severity: Major
Apalutamide and Riociguat: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Apalutamide may lower riociguat concentrations and reduce its efficacy in pulmonary hypertension. Worsening exercise capacity or symptoms may result.
What this interaction means in plain words
Apalutamide and Riociguat can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Apalutamide belongs to Endocrine; Riociguat belongs to Cardiovascular.
Why it happens
Apalutamide induces CYP3A4 (and CYP1A1-related pathways), increasing the metabolism of riociguat.
What to do
Avoid if possible. If coadministered, monitor clinical response and consider riociguat dose titration based on tolerability and symptoms.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Apalutamide
- Apalutamide + Cabotegravir Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Apalutamide + Doravirine Contraindicated
- Apalutamide + Elbasvir / grazoprevir Contraindicated
- Apalutamide + Ensitrelvir Contraindicated
- Apalutamide + Fostemsavir Contraindicated
Other interactions of Riociguat
- Avanafil + Riociguat Contraindicated
- Dipyridamole + Riociguat Contraindicated
- Isosorbide dinitrate + Riociguat Contraindicated
- Isosorbide mononitrate + Riociguat Contraindicated
- Nitroglycerin + Riociguat Contraindicated
- Riociguat + Sildenafil Contraindicated
Frequently asked questions
Can I take Apalutamide with Riociguat?
MediHelp rates the interaction as major. Apalutamide and Riociguat can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Apalutamide may lower riociguat concentrations and reduce its efficacy in pulmonary hypertension. Worsening exercise capacity or symptoms may result.
How serious is the interaction between Apalutamide and Riociguat?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid if possible. If coadministered, monitor clinical response and consider riociguat dose titration based on tolerability and symptoms.
What other medicines interact with Apalutamide?
MediHelp also lists interactions of Apalutamide with, for example, Cabotegravir, Cobicistat, Doravirine. The full list is on the Apalutamide page.
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