Drug & supplement interaction

Puravive + Riociguat

Riociguat brand name: Adempas.

Minor Interaction
Medically reviewed by · Updated February 2024
The bottom line Minor

Riociguat falls into 3 drug categories that Puravive can interact with; the most serious is rated minor. Puravive contains Panax ginseng. Panax ginseng has the potential to affect the breakdown of drugs that are metabolized by an enzyme called CYP3A4.

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

Puravive and Riociguat

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

Why Are There 3 Interactions?

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

Minor

Cytochrome P450 3A4 (Cyp3A4) Substrates

1 of 3

Why this applies to Riociguat

Riociguat falls under Cytochrome P450 3A4 (Cyp3A4) Substrates — the group Puravive interacts with.

Puravive contains Panax ginseng. Panax ginseng has the potential to affect the breakdown of drugs that are metabolized by an enzyme called CYP3A4. One example of such a drug is imatinib. There was a case where imatinib was thought to have caused liver damage, and it was believed that this might have been due to Panax ginseng inhibiting CYP3A4, which is involved in imatinib's metabolism (https://pubmed.ncbi.nlm.nih.gov/20332334/). On the other hand, Panax ginseng has been found to increase the breakdown of another drug called midazolam, which is also metabolized by CYP3A4 (https://pubmed.ncbi.nlm.nih.gov/21646440/), suggesting Panax ginseng induces CYP3A4 in some cases (i.e., makes more potent). Given these contradictory findings, it is important to use Panax ginseng cautiously if you are taking medications that are metabolized by CYP3A4, as the interaction between Panax ginseng and these drugs is not fully understood.
Severity Minor 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 situation with Puravive and Adempas (riociguat). Puravive contains Panax ginseng, which can tug on a liver enzyme called CYP3A4. Riociguat is partly cleared by that same enzyme, so in theory ginseng could change how much riociguat stays in your body. The tricky part is that ginseng has gone both directions in studies, sometimes slowing this enzyme and sometimes speeding it up, so we can't predict which way it would push.

Why this matters: riociguat lowers blood pressure. If levels rose, you could feel more dizziness, lightheadedness, headache, or fainting. If levels dropped, your PAH or CTEPH might not be as well controlled. The evidence here is weak and the effect is rated minor, so I wouldn't panic, but please run Puravive by your pharmacist or doctor before combining them.

Contact Dr. Brian directly if you have additional questions on this interaction
Minor

Antihypertensive Drugs

2 of 3

Riociguat also falls under Antihypertensive Drugs.

Puravive contains quercetin, which has been found to slightly reduce blood pressure in individuals with mild hypertension (https://pubmed.ncbi.nlm.nih.gov/17951477/). There is a theoretical possibility that it could enhance the blood pressure-lowering effects of antihypertensive medications.
Severity Minor Likelihood Possible Evidence C

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 with Riociguat (Adempas): one ingredient in Puravive, quercetin, has shown a mild blood-pressure-lowering effect in some people. Riociguat already works by relaxing your blood vessels, so stacking the two could, in theory, nudge your blood pressure a little lower than expected.

If that happens, you might notice more dizziness, lightheadedness, headache, or feeling faint, especially when you stand up quickly. Honestly, though, this is a minor, theoretical concern based on weak evidence, not a well-documented danger. Still, low blood pressure already comes with Riociguat, so I'd mention any Puravive plans to your doctor or pharmacist first, and let them know if you start feeling unusually woozy.

Contact Dr. Brian directly if you have additional questions on this interaction
Minor

P-Glycoprotein Substrates

3 of 3

Riociguat also falls under P-Glycoprotein Substrates.

Puravive contains quercetin. Theoretically, concurrent use of quercetin and P-glycoprotein substrates might alter the effects and adverse effects of the drugs. There is preliminary evidence suggesting that quercetin inhibits the P-glycoprotein efflux pump in the gastrointestinal tract. This inhibition could potentially increase the bioavailability and serum levels of drugs transported by this pump. For example, a small study in healthy volunteers found that pretreatment with quercetin increased bioavailability and plasma levels following a single dose of cyclosporine (Neoral, Sandimmune) (source: https://pubmed.ncbi.nlm.nih.gov/15581264/). However, other small studies have shown that quercetin might decrease the absorption of talinolol, another substrate of the gastrointestinal P-glycoprotein efflux pump. Interestingly, several days of quercetin treatment did not significantly affect the pharmacokinetics of saquinavir (Invirase) in another small study (source: https://pubmed.ncbi.nlm.nih.gov/16945047/). The reason for these discrepancies is not entirely clear. Until more is known, it is advisable to use quercetin cautiously in combination with P-glycoprotein substrates.
Severity Minor Likelihood Possible Evidence C

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 for Adempas (riociguat). One ingredient in Puravive is quercetin, and early lab work hints that quercetin can block a gut transporter called P-glycoprotein. Riociguat is partly moved by that transporter, so in theory blocking it could let a bit more riociguat get absorbed into your blood.

If levels nudged up, you might notice more of riociguat's usual effects, mainly low blood pressure (dizziness, lightheadedness, or feeling faint), headache, or an upset stomach. That said, this is theoretical and based on small, mixed studies, not on riociguat itself, so it may not amount to much. Since riociguat is carefully dose-adjusted for your blood pressure, I'd still run Puravive by your pharmacist or doctor before starting it.

Contact Dr. Brian directly if you have additional questions on this interaction

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

Puravive Also Interacts With Other Medications

Puravive has 357 moderate, 880 minor 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.

Moderate 357 Minor 880 No known interaction 1,593 (incl. Riociguat)
Taking anything else?

Check Another of Your Medications Against Puravive

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

From our Q&A

Questions About Puravive or Riociguat

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Puravive or Riociguat, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Riociguat

This page covers Puravive 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

How much people look this up

Where Puravive 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 Puravive
Top half

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

29 days ago today
Medication Riociguat
Steady interest

#2,025 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 Puravive

What is Puravive?

Puravive
  • Weight management
  • Metabolism support
  • Energy levels
  • General wellness
  • Stress and brain health

Puravive is a branded, multi-ingredient capsule marketed mainly for weight loss by claiming to boost brown fat activity, but there is no published, independent clinical research showing the product itself works for this purpose. Some individual ingredients have been studied in laboratory or small human studies, but those results do not prove the finished blend is safe or effective. Talk to a pharmacist or doctor before trying it, especially if you have health conditions or take medications.

Read the full Puravive 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 & Puravive

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

0Major
357Moderate
880Minor
1,592No known interaction
357 Moderate 880 Minor 1,592 No interaction
Moderate

357 interactions

Showing 60 of 357 moderate interactions — see all 357 on the Puravive page.

Minor

880 interactions

Showing 60 of 880 minor interactions — see all 880 on the Puravive page.

No interaction 1,592 drugs checked — show the list

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

Showing the 60 most looked-up of 1,592 medications checked with no known interaction — see the full Puravive list.

See the full Puravive 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
Puravive 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 Puravive and Riociguat Together: Common Questions

Can you take Puravive with Riociguat?
There is only a minor interaction, which is usually not serious. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 3 interactions listed for Puravive and Riociguat?
Riociguat belongs to more than one drug category, and Puravive 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 Puravive and Riociguat interaction?
We rate it Minor. This interaction is generally not clinically significant, but it remains worth noting and discussing with your pharmacist.

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

Still Have a Question About Riociguat and Puravive?

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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.