Isosorbide mononitrate and Riociguat interaction
Isosorbide mononitrate and Riociguat: both prescribing labels flag this combination with the strongest language, such as a contraindication, a boxed warning, or an instruction to avoid it.
Do not combine without a prescriber's guidance. The label language below is the strongest FDA uses.
What the FDA labels say
From the Isosorbide mononitrate label · effective 2019-11-01
Do not use isosorbide mononitrate in patients who are taking the soluble guanylate cyclase stimulator riociguat.
Concomitant use of isosorbide mononitrate with riociguat, a soluble guanylate cyclase stimulator, is contraindicated (see CONTRAINDICATIONS).
The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators.
From the Riociguat (Adempas) label · effective 2026-08-13
• Use with nitrates or nitric oxide donors in any form ( 4.2 , 7.1 )
Nitrates and Nitric Oxide Donors Co-administration of Adempas with nitrates or nitric oxide donors (such as amyl nitrite) in any form is contraindicated [see Drug Interactions (7.1) and Clinical Pharmacology (12.2) ] .
Nitrates: Co-administration of Adempas with nitrates or nitric oxide donors (such as amyl nitrite) in any form is contraindicated because of hypotension [see Contraindications (4.2) and Clinical Pharmacology (12.2) ] .
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Open in the checkerNot medical advice. Interaction Checker quotes FDA label text and NIH fact sheets. Whether an interaction matters for you depends on doses, timing, kidney and liver function, and other conditions. Confirm with a pharmacist or prescriber.