Drug interactions
Milrinone + Riociguat
Severity: Major
Milrinone 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
Both drugs lower vascular resistance, milrinone through PDE3 inhibition and riociguat through soluble guanylate cyclase stimulation. Combined use may cause additive hypotension. Riociguat labeling contraindicates PDE5 inhibitors but data with other PDE inhibitors are limited.
What this interaction means in plain words
Milrinone 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.
Milrinone belongs to Cardiovascular; Riociguat belongs to Cardiovascular.
Why it happens
Additive vasodilation through increased cyclic AMP (PDE3 inhibition) and increased cyclic GMP (sGC stimulation).
What to do
Monitor blood pressure closely when combining, particularly when starting or changing doses. Consider a lower riociguat starting dose and hold up-titration while on milrinone.
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 Milrinone
- Anagrelide + Milrinone Major
- Cilostazol + Milrinone Major
- Enoximone + Milrinone Major
- Inamrinone + Milrinone Major
- Milrinone + Olprinone Major
- Milrinone + Ozanimod Minor
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 Milrinone with Riociguat?
MediHelp rates the interaction as major. Milrinone 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. Both drugs lower vascular resistance, milrinone through PDE3 inhibition and riociguat through soluble guanylate cyclase stimulation. Combined use may cause additive hypotension. Riociguat labeling contraindicates PDE5 inhibitors but data with other PDE inhibitors are limited.
How serious is the interaction between Milrinone 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: Monitor blood pressure closely when combining, particularly when starting or changing doses. Consider a lower riociguat starting dose and hold up-titration while on milrinone.
What other medicines interact with Milrinone?
MediHelp also lists interactions of Milrinone with, for example, Anagrelide, Cilostazol, Enoximone. The full list is on the Milrinone page.
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