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Drug Interactions between Rezdiffra and riociguat

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

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Interactions between your drugs

Moderate

riociguat resmetirom

Applies to: riociguat and Rezdiffra (resmetirom)

MONITOR: Coadministration with resmetirom may increase the plasma concentrations and effects of drugs that are substrates of hepatic uptake transporters organic anion transporting polypeptides (OATP) 1B1, OATP 1B3, and/or the intestinal and hepatobiliary efflux transporter breast cancer resistance protein (BCRP). Resmetirom is both a substrate and an inhibitor of these transporters. Clinical studies exist for resmetirom with OATP1B1 and OATP1B3 substrates, simvastatin, and pravastatin; as well as with rosuvastatin and atorvastatin which are BCRP, OATP1B1 and OATP1B3 substrates. Resmetirom was shown to increase the systemic exposure (AUC) of simvastatin, pravastatin, rosuvastatin, and atorvastatin by 1.7-fold, 1.4-fold, 1.8-fold, and 1.4-fold, respectively. Clinical data are not available for other OATP 1B1, OATP 1B3 and/or BCRP substrates.

MANAGEMENT: Caution and closer monitoring may be advised if resmetirom is coadministered with drugs that are substrates of the OATP 1B1, OATP 1B3, and/or BCRP transporters. Dosage adjustments as well as clinical and laboratory monitoring for the development of adverse effects may be appropriate for some drugs whenever resmetirom is added to or withdrawn from therapy. Individual product labeling should be consulted for further guidance.

References (1)
  1. (2024) "Product Information. Rezdiffra (resmetirom)." Madrigal Pharmaceuticals, Inc.

Drug and food interactions

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: Patients should be advised to stop smoking. Riociguat dosages higher than 2.5 mg three times a day may be considered in cigarette smokers, if tolerated, 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. The tablet form of riociguat can generally be taken with or without food. Some authorities recommend not to switch between fed and fasted riociguat intake because of increased peak plasma levels of riociguat in the fasting compared to the fed state.

References (3)
  1. (2013) "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc
  2. (2023) "Product Information. Adempas (riociguat)." Merck Sharp & Dohme (UK) Ltd
  3. (2014) "Product Information. Adempas (riociguat)." Bayer Australia Limited

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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