Drug interactions
Itraconazole + Riociguat
Severity: Major
Itraconazole and Riociguat: major interaction.
Last updated Sources: US FDA label
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
Itraconazole raises riociguat exposure by inhibiting both CYP3A4 and P-glycoprotein/BCRP pathways. This increases the risk of symptomatic hypotension.
What this interaction means in plain words
Itraconazole 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.
Itraconazole belongs to Anti Fungals; Riociguat belongs to Cardiovascular.
Why it happens
Strong CYP3A4 and P-gp/BCRP inhibition reduces riociguat clearance.
What to do
Avoid or use with caution per labeling; if combined, consider starting riociguat at 0.5 mg three times daily and monitor blood pressure closely.
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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References
Other interactions of Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole 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 Itraconazole with Riociguat?
MediHelp rates the interaction as major. Itraconazole 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. Itraconazole raises riociguat exposure by inhibiting both CYP3A4 and P-glycoprotein/BCRP pathways. This increases the risk of symptomatic hypotension.
How serious is the interaction between Itraconazole 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 or use with caution per labeling; if combined, consider starting riociguat at 0.5 mg three times daily and monitor blood pressure closely.
What other medicines interact with Itraconazole?
MediHelp also lists interactions of Itraconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Itraconazole page.
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