Riociguat and Isosorbide Dinitrate: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Riociguat
Isosorbide Dinitrate
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased risk of hypotension
Interaction Deep Dive
Coadministration of riociguat with nitrates, or nitric oxide donors, in any form, is contraindicated. During pharmacokinetic studies, administration of riociguat 2.5 mg potentiated the hypotensive effects of sublingual nitroglycerin 0.4 mg when taken 4 and 8 hours after riociguat, with syncope reported in some patients1.
Why it happens (mechanism)
Unknown
Common questions
Can I take Riociguat and Isosorbide Dinitrate together?
Increased risk of hypotension Always confirm with your pharmacist or prescriber before making any change.
How serious is the Riociguat and Isosorbide Dinitrate interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Riociguat or Isosorbide Dinitrate need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: Adempas oral tablets, riociguat oral tablets. Bayer HealthCare Pharmaceuticals Inc. (per manufacturer), Whippany, NJ, 2013. DailyMed
Keep reading about Riociguat
Keep reading about Isosorbide Dinitrate
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist