Drug General Information (ID: DDIJKOVS5F)
Drug Name			Isosorbide mononitrate		Drug Info		Riociguat		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Vasodilator Agents				Vasodilator Agents
Structure

Mechanism of Isosorbide mononitrate-Riociguat Interaction (Severity Level: Major)
Additive hypotensive effects Click to Show/Hide Mechanism Graph
Drug Name		Isosorbide mononitrate				Riociguat
Mechanism		Hypotensive effects Guanylate cyclase  Agonist				Hypotensive effects Soluble guanylyl cyclase  Agonist
Key Mechanism Factor 1
		Factor Name		Guanylate cyclase soluble				Structure Sequence
		Protein Family		Adenylyl cyclase class-4/guanylyl cyclase family
		Protein Function		There are two types of guanylate cyclases: soluble forms and membrane-associated receptor forms. Activated by nitric oxide in the presence of magnesium or manganese ions.     Click to Show/Hide
Key Mechanism Factor 2
		Factor Name		Guanylate cyclase soluble				Structure Sequence
		Protein Family		Adenylyl cyclase class-4/guanylyl cyclase family
		Protein Function		Mediates responses to nitric oxide (NO) by catalyzing the biosynthesis of the signaling molecule cGMP.     Click to Show/Hide
Mechanism Description		Additive hypotensive effects by the combination of Isosorbide mononitrate and Riociguat

Recommended Action
Management		Concomitant use of riociguat with organic nitrates (e.g., nitroglycerin) or nitric oxide donors (e.g., amyl nitrite) in any form is considered contraindicated.

References
1	Product Information. Adempas (riociguat). Bayer Pharmaceutical Inc, West Haven, CT.