Drug interactions
Bosentan + Riociguat
Severity: Moderate
Bosentan and Riociguat: moderate 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
Both drugs are used in pulmonary hypertension, and bosentan may reduce riociguat exposure through CYP3A4 induction. Reduced exposure could lessen benefit, although the clinical impact appears modest, and additive hypotension is also possible.
What this interaction means in plain words
Bosentan and Riociguat can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Bosentan belongs to Miscellaneous; Riociguat belongs to Cardiovascular.
Why it happens
Bosentan induces CYP3A4, which contributes to riociguat clearance, and both drugs lower pulmonary vascular resistance.
What to do
Monitor blood pressure and clinical response when combining them, and titrate riociguat according to tolerability and effect. Reassess if bosentan is started or stopped.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan Major
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 Bosentan with Riociguat?
MediHelp rates the interaction as moderate. Bosentan and Riociguat can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Both drugs are used in pulmonary hypertension, and bosentan may reduce riociguat exposure through CYP3A4 induction. Reduced exposure could lessen benefit, although the clinical impact appears modest, and additive hypotension is also possible.
How serious is the interaction between Bosentan and Riociguat?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure and clinical response when combining them, and titrate riociguat according to tolerability and effect. Reassess if bosentan is started or stopped.
What other medicines interact with Bosentan?
MediHelp also lists interactions of Bosentan with, for example, Cyclosporin, Glibenclamide, Glyburide-metformin. The full list is on the Bosentan page.
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