Riociguat : Uses, Side Effects, Interactions & More

Do not take riociguat if you are pregnant or plan to become pregnant. Riociguat can harm the fetus. If you are sexually active and can become pregnant, you should not start taking riociguat until a pregnancy test has shown that you are not pregnant. You should use reliable contraceptive methods during treatment and for one month after stopping riociguat. Don’t have unprotected sex. Talk to your doctor about birth control methods that work for you. Call your doctor immediately if you miss a menstrual period or think you may be pregnant while taking riociguat.

If you are the parent or guardian of a woman who has not yet reached puberty, check your child regularly to see if she is developing signs of puberty (breast buds, pubic hair) and inform your doctor of any changes. Your child may reach puberty before having her first menstrual period.

Due to the risk of birth defects, riociguat is only available through a special restricted distribution program. A program called Adempas’ Risk Assessment and Mitigation Strategies Program (REMS) has been established for all female patients to ensure that pregnancy tests are performed every month during treatment and for 1 month after stopping riociguat treatment. They are registered in the Adempas REMS program. During enrollment, you will choose a certified specialty pharmacy that will send you your medication. Ask your doctor if you have any questions about how you will receive your medicine.

Your doctor or pharmacist will provide you with the manufacturer’s patient information sheet (Medication Guide) when you start treatment with riociguat and each time you get a refill. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website ( to obtain the Medication Guide.

Talk to your doctor about the risks of taking riociguat.

Why is this medication prescribed?
Riociguat is used to treat pulmonary arterial hypertension (PAH; high blood pressure in the vessels that carry blood to the lungs). Riociguat is also used to treat chronic thromboembolic pulmonary hypertension (CTEPH; high blood pressure in the pulmonary arteries caused by blood clots that reduce or block blood flow) in adults who cannot have surgery or for those treated with surgery who continue to have high pulmonary blood. pressure levels after surgery. Riociguat may improve the ability to exercise in people with PAH and HPTEC and may delay the worsening of symptoms in people with PAH. Riociguat belongs to a class of medications called soluble guanylate cyclase (sGC) stimulators. It works by relaxing the blood vessels in the lungs to allow blood to flow easily.

How should this medicine be used?
Riociguat comes as a tablet to take by mouth. It is usually taken with or without food 3 times a day. Take riociguat at about the same time (s) every day and space your doses 6 to 8 hours apart. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part you do not understand. Take riociguat exactly as directed. Do not take more or less or take it more often than prescribed by your doctor.

If you can’t swallow the tablet whole, you can crush it and mix the contents with a small amount of water or a soft food like applesauce. Swallow the mixture just after mixing.

Your doctor may start with a low dose of riociguat and gradually increase your dose, not more than once every 2 weeks. Your doctor may decrease your dose if you experience side effects.

Other uses for this medicine
This medication may be prescribed for other uses; Ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking Riociguat,

  • Tell your doctor and pharmacist if you are allergic to riociguat, any other medications, or any of the ingredients in riociguat tablets. Consult your pharmacist or consult the Medication Guide for a list of ingredients.
  • Tell your doctor if you are taking or have recently taken a nitrate such as isosorbide dinitrate (Isordil, in BiDil), isosorbide mononitrate (Monoket), or nitroglycerin (Nitro-Dur, Nitromist, Nitrostat, Minitran, Rectiv, others) ; phosphodiesterase inhibitors (PDE-5) such as avanafil (Stendra), sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis) or vardenafil (Levitra, Staxyn); or if you are taking dipyridamole (Persantine, in Aggrenox) or theophylline (Theo-24, Theochron, Theolair, others). Your doctor will probably tell you not to take riociguat if you are taking one or more of these medications. Do not take riociguat within 24 hours before or after taking sildenafil or within 24 hours before or 48 hours after taking tadalafil.
  • Tell your doctor and pharmacist what other prescription and over-the-counter medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antifungals like itraconazole (Onmel, Sporanox) and ketoconazole (Extin, Nizoral, Xolegel); HIV protease inhibitors, including ritonavir (Norvir, in Kaletra); certain seizure medications such as carbamazepine (Epitol, Equetro, Tegretol, others), phenobarbital, and phenytoin (Dilantin, Phenytek); and medications for high blood pressure. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • If you are taking antacids that contain aluminum hydroxide or magnesium hydroxide (Maalox, Mylanta, Tums, others), take them 1 hour before or 1 hour after taking riociguat.
  • Tell your doctor what herbal products you are taking, especially St. John’s wort.
  • Tell your doctor if you have pulmonary hypertension with idiopathic interstitial pneumonia (PH-IIP; lung disease). Your doctor will probably tell you not to take riociguat.
  • Tell your doctor if you currently smoke or start or stop smoking during treatment. Also tell your doctor if you have recently had diarrhea, vomiting, or excessive sweating, which may have caused dehydration (loss of a large amount of body fluids); any bleeding from your lung (s); if you have had a procedure to prevent you from coughing up blood; if you have low blood pressure, pulmonary veno-occlusive disease (a blockage of veins in the lungs); or heart, kidney, or liver disease.
  • Tell your doctor if you are breastfeeding. Do not breastfeed while taking riociguat.
  • You should know that riociguat can cause dizziness and lightheadedness. Do not drive a car or operate machinery until you know how this medicine affects you.

What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?
Skip the missed dose and continue your regular dosing schedule. If you forget to take riociguat for more than 3 days, call your doctor. Your doctor may want to restart your medication at a lower dose.

What side effects can this medication cause?

Riociguat may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • headache
  • constipation
  • heartburn
  • upset stomach
  • nausea
  • vomiting
  • diarrhea
  • swelling of your hands, legs, feet, and ankles

Some side effects can be serious. If you experience any of these symptoms or those in the SPECIAL PRECAUTIONS section, call your doctor immediately or get emergency medical treatment:

  • coughing up pink, frothy sputum or blood
  • fainting
  • chest pain
  • shortness of breath

Riociguat may cause other side effects. Call your doctor if you have any unusual problems while taking this medicine.

If you experience a serious side effect, you or your doctor can submit an online report to the Food and Drug Administration (FDA) MedWatch Adverse Event Reporting Program ( or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?
Keep this medicine in its container, tightly closed and out of the reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unnecessary medications must be disposed of in a special way to ensure that pets, children and others cannot consume them. However, you should not flush this medicine down the toilet. Instead, the best way to get rid of your medication is through a medication take-back program. Talk to your pharmacist or contact your local garbage / recycling department for information on return programs in your community. Consult the FDA’s Safe Drug Disposal website ( for more information if you do not have access to a take-back program.

It is important to keep all medications out of the sight and reach of children, as many containers (such as those for taking weekly pills and those used for eye drops, creams, patches, and inhalers) are not resistant to children and children. young children can easily open them. To protect young children from poisoning, always close the safety caps and immediately put the medicine in a safe place, one that is above and out of your sight and reach.

In case of emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at If the victim collapsed, had a seizure, is having trouble breathing, or cannot wake up, call 911 immediately.

What other information should I know?
Keep all your appointments with your doctor. Your doctor will check your blood pressure regularly during your treatment with riociguat.

Do not let anyone else take your medicine.

It is important that you keep a written list of all prescription and over-the-counter (non-prescription) medications you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should carry this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand Names

  • Adempas

Disclaimer: We have made every effort to ensure that all information is factually accurate, comprehensive and up-to-date. However, this article should not be used as a licensed health care professional’s choice of knowledge and expertise. You should always consult your doctor or other health care professional before taking any medication. The information given here is subject to change and it has not been used to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions or adverse effects. The lack of warning or other information for any drug does not indicate that the combination of medicine or medication is safe, effective or appropriate for all patients or all specific uses.

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