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Drug Interactions between macitentan / tadalafil and riociguat

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

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Interactions between your drugs

Major

tadalafil riociguat

Applies to: macitentan / tadalafil and riociguat

Using riociguat together with tadalafil is not recommended. Combining these medications may significantly lower your blood pressure. You may be more likely to experience side effects such as dizziness, lightheadedness, fainting, flushing, headache, and nasal congestion. In some situations, your healthcare team may transition you from riociguat to a phosphodiesterase (PDE)-5 inhibitor (i.E., sildenafil, tadalafil) or vice versa to better treat your pulmonary arterial hypertension. If this occurs, you will need to stop the old medication for a period of time before starting the new medication. You may also require additional monitoring of your blood pressure during the transition. Be sure to discuss this and any other questions you have with your healthcare provider. Avoid driving or operating hazardous machinery until you know how these medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Drug and food interactions

Moderate

tadalafil food

Applies to: macitentan / tadalafil

Tadalafil can lower blood pressure, and combining it with alcohol may further increase this effect. You may be more likely to experience symptoms such as dizziness, lightheadedness, fainting, flushing, headache, and heart palpitations. You should avoid or limit the use of alcohol to not more than 4 alcohol-containing drinks during a small period of time while being treated with tadalafil, and use caution when getting up from a sitting or lying position. You may also want to avoid drinking large amounts of grapefruit juice, since it may increase the blood levels and effects of tadalafil. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

riociguat food

Applies to: riociguat

Chemical substances present in cigarette smoke may reduce the blood levels of riociguat. This means that the medication may be less effective if you smoke during treatment. Let your doctor know if you are a smoker, or if you start smoking or stop smoking during treatment with riociguat, because the dosage may need to be adjusted. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Food may affect the absorption and blood levels of riociguat. To avoid significant fluctuations in blood levels of the medication, riociguat should be taken about the same time each day consistently either with or without food.

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:

  • macitentan/tadalafil
  • riociguat

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.

Medical Disclaimer