Drug Interactions between Jay-Phyl and riociguat
This report displays the potential drug interactions for the following 2 drugs:
- Jay-Phyl (dyphylline/guaifenesin)
- riociguat
Interactions between your drugs
dyphylline riociguat
Applies to: Jay-Phyl (dyphylline / guaifenesin) and riociguat
CONTRAINDICATED: Coadministration of riociguat with phosphodiesterase (PDE) inhibitors may cause significant hypotension. The mechanism involves peripheral vasodilation secondary to enhanced levels of cyclic guanosine monophosphate (cGMP) in vascular smooth muscle cells, as PDE inhibitors prevent degradation of cGMP while riociguat promotes its synthesis by stimulating soluble guanylate cyclase (sGC), an enzyme in the cardiopulmonary system that binds with nitric oxide (NO) to catalyze the synthesis of cGMP. In seven study patients with pulmonary arterial hypertension (PAH) on stable sildenafil treatment (20 mg three times a day), coadministration of single doses of riociguat (0.5 mg and 1 mg sequentially) demonstrated additive hemodynamic effects. One death has been reported in clinical studies of PAH patients on stable sildenafil treatment receiving riociguat 1 to 2.5 mg three times a day, and there was a high rate of discontinuation for hypotension. Riociguat does not affect the pharmacokinetics of sildenafil.
MANAGEMENT: Concomitant use of riociguat with PDE inhibitors, including specific PDE-5 inhibitors (e.g., avanafil, sildenafil, tadalafil, vardenafil) or nonspecific PDE inhibitors (e.g., dipyridamole, theophylline), is considered contraindicated. Riociguat should be discontinued at least 24 hours before administering a PDE-5 inhibitor, and avoidance of riociguat administration within 24 hours after sildenafil or within 48 hours after tadalafil is recommended. Limited data exists for other PDE inhibitors.
References
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Cerner Multum, Inc. "Australian Product Information."
- (2013) "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc
Drug and food interactions
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
- (2013) "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc
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.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
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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