Drug interactions
Isosorbide dinitrate + Riociguat
Severity: Contraindicated
Isosorbide dinitrate and Riociguat: contraindicated 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 increase cyclic GMP signalling in vascular smooth muscle, and together they can cause profound, sometimes refractory hypotension and syncope. Riociguat labeling contraindicates its use with nitrates in any form.
What this interaction means in plain words
Isosorbide dinitrate and Riociguat are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Isosorbide dinitrate belongs to Cardiovascular; Riociguat belongs to Cardiovascular.
Why it happens
Nitrates release nitric oxide while riociguat stimulates soluble guanylate cyclase, producing additive cGMP-mediated vasodilation.
What to do
Do not co-administer riociguat with isosorbide dinitrate or other nitrates. Choose a non-nitrate antianginal if one is needed.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Isosorbide dinitrate
- Avanafil + Isosorbide dinitrate Contraindicated
- Isosorbide dinitrate + Sildenafil Contraindicated
- Isosorbide dinitrate + Tadalafil Contraindicated
- Isosorbide dinitrate + Vardenafil Contraindicated
- Ergotamine + Isosorbide dinitrate Major
- Isosorbide dinitrate + Methylergonovine Major
Other interactions of Riociguat
- Avanafil + Riociguat Contraindicated
- Dipyridamole + Riociguat Contraindicated
- Isosorbide mononitrate + Riociguat Contraindicated
- Nitroglycerin + Riociguat Contraindicated
- Riociguat + Sildenafil Contraindicated
- Riociguat + Tadalafil Contraindicated
Frequently asked questions
Can I take Isosorbide dinitrate with Riociguat?
MediHelp rates the interaction as contraindicated. Isosorbide dinitrate and Riociguat are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Both drugs increase cyclic GMP signalling in vascular smooth muscle, and together they can cause profound, sometimes refractory hypotension and syncope. Riociguat labeling contraindicates its use with nitrates in any form.
How serious is the interaction between Isosorbide dinitrate and Riociguat?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not co-administer riociguat with isosorbide dinitrate or other nitrates. Choose a non-nitrate antianginal if one is needed.
What other medicines interact with Isosorbide dinitrate?
MediHelp also lists interactions of Isosorbide dinitrate with, for example, Avanafil, Sildenafil, Tadalafil. The full list is on the Isosorbide dinitrate page.
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