Drug interactions
Ketoconazole + Riociguat
Severity: Major
Ketoconazole 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
Ketoconazole inhibits both CYP-mediated metabolism and BCRP-mediated efflux of riociguat, raising its exposure. This may cause symptomatic hypotension.
What this interaction means in plain words
Ketoconazole 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.
Ketoconazole belongs to Anti Fungals; Riociguat belongs to Cardiovascular.
Why it happens
Inhibition of multiple CYP enzymes (including CYP3A) and BCRP reduces riociguat clearance.
What to do
Consider a starting dose of 0.5 mg three times daily and monitor for hypotension, reducing the dose if symptoms occur.
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 Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole 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 Ketoconazole with Riociguat?
MediHelp rates the interaction as major. Ketoconazole 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. Ketoconazole inhibits both CYP-mediated metabolism and BCRP-mediated efflux of riociguat, raising its exposure. This may cause symptomatic hypotension.
How serious is the interaction between Ketoconazole 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: Consider a starting dose of 0.5 mg three times daily and monitor for hypotension, reducing the dose if symptoms occur.
What other medicines interact with Ketoconazole?
MediHelp also lists interactions of Ketoconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Ketoconazole page.
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