PHARMACODYNAMIC INTERACTIONS1
Co-administration of Adempas with nitrates or nitric oxide donors
(such as amyl nitrite) in any form is contraindicated because of hypotension.
Co-administration of Adempas with specific PDE-5 inhibitors (such as sildenafil, tadalafil, or vardenafil) and nonspecific PDE inhibitors (such as dipyridamole or theophylline) is contraindicated because of hypotension. Clinical experience with co-administration of Adempas and other phosphodiesterase inhibitors (such as milrinone, cilostazole, roflumilast) is limited.
To transition patients to and from a PDE-5 inhibitor to Adempas,
follow the timing information in the Dosing and Administration Guide.
PDE-5=phosphodiesterase type 5
Pharmacokinetic interactions considerations1
Concomitant use of riociguat with strong cytochrome CYP inhibitors and P-gp/BCRP inhibitors such as azole antimycotics (for example, ketoconazole, itraconazole) or HIV protease inhibitors (such as ritonavir) increase riociguat exposure and may result in hypotension.
CYP=cytochrome P450; P-gp/BCRP=P-glycoprotein/breast cancer resistance protein
Strong inducers of CYP3A (such as rifampin, phenytoin, carbamazepine, phenobarbital, or St. John's Wort) may significantly reduce riociguat exposure. Data are not available to guide dosing of riociguat when strong CYP3A inducers are co-administered.
CYP3A=cytochrome P450, family 3, subfamily A
Antacids such as aluminum hydroxide/magnesium hydroxide decrease riociguat absorption and should not be taken within 1 hour of taking Adempas.
Help your patients manage possible side effects.
Download the patient guide here.