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Drug Interactions between Adempas and Tyvaso

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

treprostinil riociguat

Applies to: Tyvaso (treprostinil) and Adempas (riociguat)

MONITOR: Riociguat may potentiate the action of antihypertensive agents and other vasodilators. Symptomatic hypotension may occur. Riociguat stimulates soluble guanylate cyclase (sGC), an enzyme in the cardiopulmonary system that binds with nitric oxide (NO) to catalyze the synthesis of cyclic guanosine monophosphate (cGMP). The resultant accumulation of cGMP in vascular smooth muscle cells leads to peripheral vasodilation and blood pressure decreases.

MANAGEMENT: Caution is advised if riociguat is prescribed in combination with antihypertensive agents or other vasodilators. A reduction in the starting dosage of riociguat to 0.5 mg three times a day should be considered for patients who may not tolerate the hypotensive effect of riociguat. Periodic systemic blood pressure monitoring is recommended. If systolic blood pressure remains greater than 95 mmHg and the patient has no signs or symptoms of hypotension, the dosage may be increased by 0.5 mg three times a day every 2 weeks as tolerated, up to a maximum of 2.5 mg three times a day. If hypotension develops at any time during treatment, the dosage should be reduced by 0.5 mg three times a day.

References

  1. (2013) "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc

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Drug and food interactions

Moderate

riociguat food

Applies to: Adempas (riociguat)

ADJUST DOSE: Smoking may decrease the plasma concentrations of riociguat. The proposed mechanism is induction of the CYP450 1A1-mediated metabolism of riociguat by polycyclic aromatic hydrocarbons present in cigarette smoke. CYP450 1A1 is responsible for the formation of the major active metabolite, M1, which has just 1/3 to 1/10 the pharmacologic activity of riociguat. According to the product labeling, plasma concentrations of riociguat are reduced by 50% to 60% in smokers compared to nonsmokers.

MANAGEMENT: Riociguat dosages higher than 2.5 mg three times a day may be considered in cigarette smokers, if tolerated, so as to match the exposure seen in nonsmoking patients. However, safety and effectiveness of higher dosages have not been established. A dosage reduction should be considered in patients who stop smoking during treatment with riociguat.

References

  1. (2013) "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Agents for pulmonary hypertension

Therapeutic duplication

The recommended maximum number of medicines in the 'agents for pulmonary hypertension' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'agents for pulmonary hypertension' category:

  • Adempas (riociguat)
  • Tyvaso (treprostinil)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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