Drug General Information (ID: DDIPXG9IZ1)
Drug Name			Riociguat		Drug Info		Isosorbide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Vasodilator Agents				Antianginal Agents
Structure

Mechanism of Riociguat-Isosorbide Interaction (Severity Level: Major)
Additive hypotensive effects Click to Show/Hide Mechanism Graph
Drug Name		Riociguat				Isosorbide
Mechanism		Hypotensive effects Soluble guanylyl cyclase  Agonist				Hypotensive effects Guanylate cyclase  Agonist
Key Mechanism Factor 1
		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
Key Mechanism Factor 2
		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
Mechanism Description		Additive hypotensive effects by the combination of Riociguat and Isosorbide

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.