Drug interactions
Riociguat + Ritonavir
Severity: Major
Riociguat and Ritonavir: 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
Ritonavir strongly inhibits CYP3A4 and P-gp/BCRP, markedly increasing riociguat exposure. This can cause symptomatic hypotension and syncope.
What this interaction means in plain words
Riociguat and Ritonavir 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.
Riociguat belongs to Cardiovascular; Ritonavir belongs to Anti Virals.
Why it happens
Ritonavir inhibits CYP3A4 and P-gp/BCRP, reducing riociguat clearance.
What to do
Consider a starting riociguat dose of 0.5 mg three times daily and monitor blood pressure and symptoms of hypotension. Avoid the combination where 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 Ritonavir
- Alfuzosin + Ritonavir Contraindicated
- Amiodarone + Ritonavir Contraindicated
- Avanafil + Ritonavir Contraindicated
- Colchicine + Ritonavir Contraindicated
- Dronedarone + Ritonavir Contraindicated
- Eletriptan + Ritonavir Contraindicated
Frequently asked questions
Can I take Riociguat with Ritonavir?
MediHelp rates the interaction as major. Riociguat and Ritonavir 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. Ritonavir strongly inhibits CYP3A4 and P-gp/BCRP, markedly increasing riociguat exposure. This can cause symptomatic hypotension and syncope.
How serious is the interaction between Riociguat and Ritonavir?
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 riociguat dose of 0.5 mg three times daily and monitor blood pressure and symptoms of hypotension. Avoid the combination where 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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