Drug interactions
Rifampicin + Riociguat
Severity: Major
Rifampicin 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
Rifampicin strongly induces CYP3A4 and other enzymes and can substantially reduce riociguat exposure, with a risk of loss of efficacy in pulmonary hypertension.
What this interaction means in plain words
Rifampicin 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.
Rifampicin belongs to Anti Bacterial; Riociguat belongs to Cardiovascular.
Why it happens
Rifampicin induces CYP3A4 and other CYP enzymes, increasing riociguat clearance.
What to do
Monitor clinical response and consider dose titration of riociguat, or use an alternative to rifampicin if possible.
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 Riociguat
- Avanafil + Riociguat Contraindicated
- Dipyridamole + Riociguat Contraindicated
- Isosorbide dinitrate + Riociguat Contraindicated
- Isosorbide mononitrate + Riociguat Contraindicated
- Nitroglycerin + Riociguat Contraindicated
- Riociguat + Sildenafil Contraindicated
Other interactions of Rifampicin
- Cabotegravir + Rifampicin Contraindicated
- Delamanid + Rifampicin Contraindicated
- Doravirine + Rifampicin Contraindicated
- Ensitrelvir + Rifampicin Contraindicated
- Fostemsavir + Rifampicin Contraindicated
- Isavuconazole + Rifampicin Contraindicated
Frequently asked questions
Can I take Rifampicin with Riociguat?
MediHelp rates the interaction as major. Rifampicin 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. Rifampicin strongly induces CYP3A4 and other enzymes and can substantially reduce riociguat exposure, with a risk of loss of efficacy in pulmonary hypertension.
How serious is the interaction between Rifampicin 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 clinical response and consider dose titration of riociguat, or use an alternative to rifampicin if possible.
What other medicines interact with Riociguat?
MediHelp also lists interactions of Riociguat with, for example, Avanafil, Dipyridamole, Isosorbide dinitrate. The full list is on the Riociguat page.
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