Medication interaction hub

What Supplements Interact with Riociguat?

Riociguat brand name: Adempas. Every interaction below applies to the brands too.

230 Interactions 6 Major 187 Moderate 37 Minor
Curated & coded by · Clinical Pharmacist · Updated September 22, 2026

Drug–supplement interaction data sourced from Natural Medicines Pro, the licensed clinical database from TRC Healthcare / Therapeutic Research, with additional analysis by the HelloPharmacist Pharmacist Team. Our sources · Editorial policy

What is this page for?

One answer, for one medication: what supplements and herbal products interact with Riociguat? Every vitamin, herb, and supplement ingredient we’ve checked against it is on this page, ranked by severity, each linking to the full report for that exact pair.

This page covers supplement interactions only — to check Riociguat against your other medications, use the drug–drug interaction checker. Educational information from our licensed clinical databases, not medical advice. Our editorial policy

HelloPharmacist Bottom Line
Our Pharmacist Explains
What is this? The interaction data in the HelloPharmacist supplement database is licensed from Natural Medicines Pro by TRC Healthcare (Therapeutic Research). HelloPharmacist pharmacists often add our own analysis and context on top of that licensed data — such as this Bottom Line summary and the notes on individual interaction pages — and any such commentary is noted as ours.

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. John's wort speeds its breakdown and can leave you undertreated. Most of the rest either change how your body processes the drug or stack their own blood-pressure lowering on top of it.

The remaining 224 entries split into 187 moderate and 37 minor, and many of the moderates are everyday items with mild pressure-lowering effects, fish oil among them. Seventeen can block absorption of anything taken by mouth, so keep those well separated from your riociguat dose. Dizziness or feeling faint when you stand is your early warning that a combination is dropping your pressure too far.

— , Clinical Pharmacist · July 18, 2026

Major 6 Moderate 187 Minor 37 No known interaction 1,222

This box checks one ingredient at a time (like turmeric or magnesium). Taking a supplement product with a whole label of ingredients? Search the product instead — we check every ingredient on it ↓

Most Viewed Ingredient Interactions

Riociguat: Top Interactions at a Glance

The Riociguat supplement & herbal interactions people checked most in the last 24 hours, colored by severity. Tap any ingredient to open the full report for that pair.

Showing the 12 highest-ranked of 230 interacting ingredients — plus 1,222 more checked with no known interaction. See the complete ranked list.

Start here

The Most-Checked Riociguat Combinations Today

The Riociguat + supplement pages people viewed most in the last 24 hours (resets at midnight). Open any card for the full report.

Major Likelihood Likely Grapefruit + Riociguati

Grapefruit juice can increase levels of drugs metabolized by CYP3A4.

Read the full interaction Moderate Likelihood Possible Vitamin B6 + Riociguati

Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.

Read the full interaction Moderate Likelihood Probable Yohimbe + Riociguati

Theoretically, yohimbe might reduce the effects of antihypertensive drugs.

Read the full interaction Moderate Likelihood Possible Asafoetida + Riociguati

Evidence from animal research suggests that asafoetida has hypotensive effects.

Read the full interaction Moderate Likelihood Possible Adrafinil + Riociguati

Theoretically, adrafinil might reduce the effects of antihypertensive drugs.

Read the full interaction Major Likelihood Likely American Hellebore + Riociguati

American hellebore can have potent cardiovascular effects due to the toxic steroid ester alkaloids it contains.

Read the full interaction
The complete list

Every Supplement Checked Against Riociguat

All 1,452 ingredients in our database, ranked by severity — 230 with a Riociguat interaction on file and 1,222 with none found. Filter by severity or search any ingredient; hover the for what each ingredient is.

Looking for an interaction with a specific supplement product? Search products instead ↓

Straight answers

Can You Take It With Riociguat?

One-line answers, one card per combination — scroll through today’s 20 and tap any card for the full report. A different set rotates in daily until every combination has had its turn.

Can you take Grapefruit with Riociguat?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Grapefruit juice can increase levels of drugs metabolized by CYP3A4.

Full Grapefruit + Riociguat answer

Can you take Vitamin B6 with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.

Full Vitamin B6 + Riociguat answer

Can you take Yohimbe with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, yohimbe might reduce the effects of antihypertensive drugs.

Full Yohimbe + Riociguat answer

Can you take Asafoetida with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Evidence from animal research suggests that asafoetida has hypotensive effects.

Full Asafoetida + Riociguat answer

Can you take Adrafinil with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, adrafinil might reduce the effects of antihypertensive drugs.

Full Adrafinil + Riociguat answer

Can you take Licorice with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, licorice might reduce the effects of antihypertensive drugs.

Full Licorice + Riociguat answer

Can you take Lime with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Animal research shows that phenolics in lime juice inhibit cytochrome P450 3A4.

Full Lime + Riociguat answer

Can you take Maitake Mushroom with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, combining maitake mushroom with antihypertensive drugs might increase the risk of hypotension.

Full Maitake Mushroom + Riociguat answer

Can you take Malic Acid with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.

Full Malic Acid + Riociguat answer

Can you take Melatonin with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, taking melatonin with antihypertensive drugs might increase the risk of hypotension or hypertension.

Full Melatonin + Riociguat answer

Can you take Methoxylated Flavones with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. In vitro evidence suggests that methoxylated flavones might inhibit cytochrome P450 3A4 (CYP3A4).

Full Methoxylated Flavones + Riociguat answer

Can you take Moringa with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, moringa might increase or decrease levels of CYP3A4 substrates.

Full Moringa + Riociguat answer

Can you take N-acetyl Cysteine (nac) with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, N-acetyl cysteine might increase the risk of hypotension when taken with antihypertensive drugs.

Full N-acetyl Cysteine (nac) + Riociguat answer

Can you take Nattokinase with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, nattokinase might increase the risk of hypotension when used with antihypertensive drugs.

Full Nattokinase + Riociguat answer

Can you take Neem with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, neem leaf extract might increase the levels and clinical effects of CYP3A4 substrates.

Full Neem + Riociguat answer

Can you take Niacin with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.

Full Niacin + Riociguat answer

Can you take Noni with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, noni may increase the risk of hypotension when used in combination with antihypertensive drugs.

Full Noni + Riociguat answer

Can you take Octopamine with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. In humans, octopamine 450-600 mg daily increases blood pressure in hypotensive patients.

Full Octopamine + Riociguat answer

Can you take Oregon Grape with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, Oregon grape might increase the risk of hypotension when taken with antihypertensive drugs.

Full Oregon Grape + Riociguat answer

Can you take Padang Cassia with Riociguat?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. In vitro research shows that a methanol extract of Padang cassia inhibits cytochrome P450 3A4 (CYP3A4) activity.

Full Padang Cassia + Riociguat answer
Read the list like a pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. Interaction 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.
  • Possible. 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
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each entry links to a full report with the clinical detail, likelihood, evidence level, and citations for that exact combination.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

How Does Our Interaction Checker Work?

Behind every verdict on this page is a category system. Our source database doesn’t document supplement interactions drug-by-drug — it documents them against groups of medications that behave the same way (for example, “drugs processed by the CYP3A4 liver enzyme” or “blood-thinning medications”).

So the check works in three steps: (1) Riociguat is classified into the pharmacology categories it belongs to, (2) every supplement interaction documented against any of those categories is inherited by Riociguat, and (3) each ingredient keeps its own severity, likelihood, and evidence grades from the underlying record. That’s why one supplement can carry several records for one drug — it may interact through more than one category.

Riociguat sits in 4 interaction categories. Open any one to see what the group means:

Cytochrome P450 3A4 (Cyp3A4) Substrates 121 ingredients

A drug-metabolism group: these medications are processed by the named liver enzyme (a cytochrome P450). Supplements that speed this enzyme up or slow it down can lower or raise the medication's levels in your body.

121 of the supplement ingredients on this page reach Riociguat through this category.

Antihypertensive Drugs 119 ingredients

Blood-pressure-lowering medications. Supplements that lower (or raise) blood pressure can amplify or fight these drugs.

119 of the supplement ingredients on this page reach Riociguat through this category.

P-Glycoprotein Substrates 37 ingredients

A drug-transport group: these medications are moved in and out of cells by the P-glycoprotein pump. Supplements that affect the pump can change how much of the drug is absorbed or kept in the body.

37 of the supplement ingredients on this page reach Riociguat through this category.

Oral Drugs 17 ingredients

A pharmacology grouping from our source database: medications in this group share a property that certain supplements are known to interact with, so an interaction documented for the group applies to every drug in it.

17 of the supplement ingredients on this page reach Riociguat through this category.

About Riociguat

Riociguat is an oral tablet used to treat two serious lung conditions: chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH).

Generic name: Riociguat  ·  Brand name: Adempas.

See the full Riociguat drug information

Related: does Riociguat deplete any nutrients?

Riociguat has 1 reported nutrient association in the research literature — see the Riociguat nutrient depletion report.

Check a real product

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Most supplements are combination products — and the interaction may come from an ingredient you didn’t buy it for. Search any product below (or scan its label) and we’ll check every ingredient on it against Riociguat.

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Pharmacist Counseling Corner

Riociguat & Supplements: Common Questions

What supplements interact with Riociguat?
More than you might expect — 230 in total, though they are far from equal: 6 are rated major, 187 moderate, and 37 minor. The ranked list on this page puts the ones that genuinely matter first, and every entry opens a full report on that exact pair. The highest-ranked right now: American Hellebore, Grapefruit, Tyramine.
Which Riociguat supplement interactions are the most serious?
Focus on the major group: American Hellebore, Grapefruit, Tyramine, Activated Charcoal and American Mistletoe, among others. A major rating means the combination can be clinically significant, not that harm is guaranteed — but it's exactly the kind of thing to run past your pharmacist before your next dose, not after. Jump to the ranked list.
Can I take vitamins or supplements while on Riociguat?
Usually yes — most people on Riociguat can take most supplements. The catch is the exceptions, and they aren't always the exotic ones (St. John's Wort trips up more prescriptions than almost anything sold next to it). Look up each ingredient you actually take in the list above, and treat "no known interaction" as a green-ish light, not a guarantee. Try the label scanner or the interaction checker.
Do brands like Adempas have the same supplement interactions as Riociguat?
Yes — Adempas all contain Riociguat, so everything on this page applies to them equally. Interactions belong to the active drug, never to the brand on the box; the same is true of generics.
Where do these interaction ratings come from?
Every rating comes from the Natural Medicines database — the same evidence-graded reference pharmacists and hospitals use — and each interaction carries three separate grades: severity (how bad it can be), likelihood (how well it's documented in studies and case reports), and an evidence level. Our pharmacists review the content; we never let an AI decide an interaction. See how to read the ratings and our editorial policy.
Does Riociguat deplete any vitamins or nutrients?
It might — Riociguat has 1 reported nutrient-depletion association in the research literature, which is a different question from interactions: instead of a supplement changing the drug, the drug may lower a nutrient over time. See the Riociguat nutrient depletion report for the specifics and what to discuss with your pharmacist.
What about Riociguat and my other medications?
This page covers Riociguat against supplements and herbal ingredients. Checking Riociguat against your other prescription or OTC medications is a different tool — our drug interaction checker covers that side. Head to the drug–drug interaction checker, or read the full Riociguat drug information.

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

Where next

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Sourcing

Where This Data Comes From — and Why You Can Trust It

🧪 Licensed clinical database

Every interaction verdict on this page comes from Natural Medicines Pro (TRC Healthcare / Therapeutic Research) — the same evidence-graded reference used by pharmacists and hospitals. We license this data directly; we do not scrape it, and no AI invents an interaction.

🧑‍⚕️ Pharmacist review

This page is curated and coded by , Clinical Pharmacist, with additional analysis by the HelloPharmacist Pharmacist Team. Editorial commentary is ours; the licensed interaction records are shown as sourced.

🔄 Kept current

Our interaction database refreshes on a weekly cycle, and this page re-checks the live database every time it’s rebuilt — what you see reflects the database as of September 22, 2026.

🔍 Full transparency

How every dataset on this site is sourced, licensed, and updated is documented publicly: our data sources · editorial policy · how we use AI.

Educational information, not medical advice. An interaction being on file does not mean it will happen to you — and absence of one is not proof of safety. Never start or stop a medication or supplement without talking to your pharmacist or doctor.