Critical
Isosorbide mononitrate × Riociguat
Long-acting organic nitrate×Soluble guanylate cyclase (sGC) stimulator
Mechanism
Riociguat activates sGC independently of NO. Nitrate adds NO – synergistic systemic hypotension. FDA Adempas Section 4.3.
Symptoms
Severe hypotension.
Management
Combination contraindicated.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Sources
- EMA: Adempas (riociguat) SmPC, Section 4.3 (2024)– EMA EPAR Adempas