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Drug Interactions between Entresto and riociguat

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

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Interactions between your drugs

Moderate

valsartan riociguat

Applies to: Entresto (sacubitril / valsartan) and 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. "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc (2013):

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Drug and food interactions

Moderate

valsartan food

Applies to: Entresto (sacubitril / valsartan)

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References

  1. "Product Information. Cozaar (losartan)." Merck & Co., Inc PROD (2001):
  2. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals PROD (2001):

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Moderate

riociguat food

Applies to: 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. "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc (2013):

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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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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