Drug & supplement interaction

Danshen + Riociguat

Riociguat brand name: Adempas.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Riociguat falls into 3 drug categories that Danshen can interact with; the most serious is rated moderate. Theoretically, taking danshen with antihypertensive drugs might increase the risk of hypotension.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Danshen and Riociguat

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Danshen interacts with whole categories of medication. Riociguat falls into 3 of those categories, so it can interact with Danshen in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

ANTIHYPERTENSIVE DRUGS

1 of 3

Why this applies to Riociguat

Riociguat falls under ANTIHYPERTENSIVE DRUGS — the group Danshen interacts with.

Theoretically, taking danshen with antihypertensive drugs might increase the risk of hypotension.
Animal research suggests that danshen can produce dose-dependent hypotensive effects. Furthermore, concomitant use with captopril appears to potentiate this effect.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the thing to know with Adempas (riociguat): it already works by relaxing your blood vessels, which naturally lowers blood pressure. Danshen, at least in animal and lab studies, seems to do something similar and may lower blood pressure too. Put the two together and you could, in theory, push your pressure down more than intended.

If that happens, you might feel dizzy, lightheaded, faint, or unusually tired, especially when standing up quickly. I'll be honest, the evidence here is weak (it's based on animal studies, not human trials), so this is more a caution than a sure thing. Still, riociguat is a serious lung medicine, so please check with your pharmacist or doctor before adding Danshen rather than starting it on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Li CP, Yung KH, and Chiu KW. Hypotensive action of Salvia miltiorrhiza cell culture extract. American Journal of Chinese Medicine 1990;18(3-4):157-166.
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 3

Riociguat also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Danshen might alter the levels and clinical effects of drugs metabolized by CYP3A4.
Preliminary clinical research in healthy males shows that the administration of danshen for 10-14 days induces intestinal CYP3A4 and increases the clearance of midazolam, a CYP3A4 substrate. The maximum concentration of midazolam was decreased by 31% to 67%, and drug levels were decreased by 27% to 80%. However, a single dose of danshen has the opposite effect, increasing maximum concentrations of midazolam by 87%.
Severity Moderate Likelihood Possible Evidence B

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the wrinkle with combining Danshen and Adempas (riociguat). Your body partly clears riociguat using a liver and gut enzyme called CYP3A4, and Danshen can mess with that enzyme in two opposite ways. Taken regularly for a week or two, Danshen seems to speed CYP3A4 up, which could clear riociguat faster and leave you with less benefit, meaning your pulmonary hypertension symptoms (shortness of breath, low exercise tolerance) might not be as well controlled.

But a single dose of Danshen did the reverse in studies, raising drug levels. With riociguat, higher levels can mean low blood pressure, dizziness, or fainting. Because this could swing either direction, please don't pair them without checking with your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Qiu F, Wang G, Zhang R, Sun J, et al. Effect of danshen extract on the activity of CYP3A4 in healthy volunteers. Br J Clin Pharmacol 2010;69:656-62. PubMed
  2. Qiu F, Jiang J, Ma Y, Wang G, Gao C, Zhang X, Zhang L, Liu S, He M, Zhu L, Ye Y, Li Q, Miao P. Opposite Effects of Single-Dose and Multidose Administration of the Ethanol Extract of Danshen on CYP3A in Healthy Volunteers. Evid Based Complement Alternat Me PubMed
Moderate

P-GLYCOPROTEIN SUBSTRATES

3 of 3

Riociguat also falls under P-GLYCOPROTEIN SUBSTRATES.

Danshen might alter the levels of drugs cleared by p-glycoprotein.
Pharmacokinetic research in healthy volunteers suggests that danshen might affect p-glycoprotein activity. Taking danshen extract 1 gram three times daily for 10 days prior to receiving fexofenadine 60 mg increases peak levels of fexofenadine, a p-glycoprotein substrate, by 27.4% and area under the curve (AUC) by 37.2%.
Severity Moderate Likelihood Possible Evidence B

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist: Danshen can interfere with a transporter called P-glycoprotein, which helps move certain medicines out of your body. Riociguat (Adempas) is one of those medicines. In a small study with another drug, Danshen pushed blood levels up by roughly a third. If the same thing happens with riociguat, you could end up with more drug in your system than intended.

Since riociguat already relaxes blood vessels, higher levels could mean low blood pressure, dizziness, lightheadedness, headache, or fainting. The evidence here is limited and rated moderate, so this isn't a sure thing, but riociguat is a medicine where blood pressure changes really matter. Please don't start or stop anything on your own. Check with your pharmacist or doctor before combining the two.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Qiu F, Zeng J, Liu S, He M, Zhu L, Ye Y, Miao P, Shen S, Jiang J. Effects of danshen ethanol extract on the pharmacokinetics of fexofenadine in healthy volunteers. Evid Based Complement Alternat Med. 2014;2014:473213. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Danshen Also Interacts With Other Medications

Danshen has 123 major, 935 moderate known drug interactions in our database — the Riociguat one above is among them. If you take anything else, check it against the full list below.

Major 123 Moderate 935 No known interaction 1,772 (incl. Riociguat)
Taking anything else?

Check Another of Your Medications Against Danshen

Covers the 2,830 medications we’ve checked against Danshen. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Riociguat

This page covers Danshen only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Riociguat page lists 230 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), American Mistletoe (major), Grapefruit (major) and St. John's Wort (major).

By severity: 6 major · 187 moderate · 37 minor.

From our pharmacist’s overview on the Riociguat page

“Riociguat (Adempas) works by relaxing the blood vessels in your lungs, which also lowers blood pressure, so I read this list of 230 supplements and herbs with real concern, and the six rated major are what to understand first. Grapefruit can push riociguat levels up and intensify its effect, while St.”

Reviewed by 2 · Jul 18, 2026

Open the Riociguat interaction page

One more smart check

Taking Danshen as Part of a Dietary Supplement Product? Check It for Interactions

We hold 18 real supplement products containing Danshen, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Danshen. Your product may carry other ingredients that interact with Riociguat too, on top of Danshen — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Danshen and Riociguat Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Danshen
Top half

#682 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Riociguat
Steady interest

#1,591 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Danshen

What is Danshen?

Danshen
  • Heart and circulation support
  • Angina (chest pain)
  • High blood pressure
  • Anxiety and stress
  • Liver health

Danshen is a root used in traditional Chinese medicine, mainly for heart and circulation problems. Some early research is promising, but the evidence is not strong enough to confirm it works for any condition, and it may affect blood clotting. Talk to a pharmacist or doctor before using it, especially if you take other medicines or have a health condition.

Read the full Danshen monograph & all interactions
Medication

About Riociguat

What Is Riociguat Used For?

Brand name: Adempas

Riociguat tablets — sold as Adempas and under the generic name Riociguat — are used to treat adults with two types of pulmonary hypertension (high blood pressure in the lungs).

The first is chronic thromboembolic pulmonary hypertension (CTEPH), a condition caused by blood clots in the lung arteries, either after surgery or when surgery is not an option. The second is pulmonary arterial hypertension (PAH), where the arteries carrying blood to the lungs are narrowed or blocked. In both conditions, riociguat helps improve exercise ability and functional status, and in PAH it also helps slow the disease from getting worse.

See full Riociguat drug information
Keep checking

Other Drugs & Danshen

Browse every other medication we’ve checked against Danshen — both the ones with a known interaction and the ones without. Select any drug for the full detail.

123Major
935Moderate
0Minor
1,771No known interaction
123 Major 935 Moderate 1,771 No interaction
Major

123 interactions

Showing 60 of 123 major interactions — see all 123 on the Danshen page.

Moderate

935 interactions

Showing 60 of 935 moderate interactions — see all 935 on the Danshen page.

No interaction 1,771 drugs checked — show the list

We also checked Danshen against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,771 medications checked with no known interaction — see the full Danshen list.

See the full Danshen interactions page
See every supplement checked against Riociguat, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Danshen monograph › Uses, safety, and every drug interaction in one place Riociguat supplement interactions › Every supplement checked against Riociguat, ranked by severity Riociguat drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Danshen and Riociguat Together: Common Questions

Can you take Danshen with Riociguat?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 3 interactions listed for Danshen and Riociguat?
Riociguat belongs to more than one drug category, and Danshen interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Danshen and Riociguat interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Riociguat and Danshen?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.