Drug interactions
Cyclosporin + Riociguat
Severity: Major
Cyclosporin 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
Cyclosporine inhibits P-gp and BCRP, which can increase riociguat exposure. This may cause excessive vasodilation with symptomatic hypotension, dizziness or syncope.
What this interaction means in plain words
Cyclosporin 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.
Cyclosporin belongs to Miscellaneous; Riociguat belongs to Cardiovascular.
Why it happens
Cyclosporine inhibits P-gp/BCRP efflux and CYP-mediated clearance, increasing riociguat plasma concentrations.
What to do
If coadministration cannot be avoided, consider a lower riociguat starting dose of 0.5 mg three times daily and monitor blood pressure. Reduce the dose if hypotension develops.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Cyclosporin and Riociguat, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
Other interactions of Cyclosporin
- Adenovirus types 4 and 7 live + Cyclosporin Contraindicated
- Aliskiren + Cyclosporin Contraindicated
- Bcg vaccine live + Cyclosporin Contraindicated
- Bosentan + Cyclosporin Contraindicated
- Cidofovir + Cyclosporin Contraindicated
- Cyclosporin + Dengue vaccine 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 Cyclosporin with Riociguat?
MediHelp rates the interaction as major. Cyclosporin 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. Cyclosporine inhibits P-gp and BCRP, which can increase riociguat exposure. This may cause excessive vasodilation with symptomatic hypotension, dizziness or syncope.
How serious is the interaction between Cyclosporin 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: If coadministration cannot be avoided, consider a lower riociguat starting dose of 0.5 mg three times daily and monitor blood pressure. Reduce the dose if hypotension develops.
What other medicines interact with Cyclosporin?
MediHelp also lists interactions of Cyclosporin with, for example, Adenovirus types 4 and 7 live, Aliskiren, Bcg vaccine live. The full list is on the Cyclosporin page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
