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Levitra and Concomitant Use of Riociguat

When mixing any other medications while on any PDE5 inhibitor, it leads to health complications and adverse body reactions that can’t be treated with regular over-the-counter meds. And though Levitra is the safest of the ED meds, its combination with riociguat has two sides: the first one triggers health issues when doses aren’t adjusted and the second one may treat the blood vessel conditions that are responsible for poor erections.

What Is Riociguat?

The drug belongs to the class of medications under the name soluble guanylate cyclase stimulators. What do they do? These drugs are widely prescribed for their ability to reduce the high blood pressure in lungs. After the administration, a riociguat opens the blood vessels that connect the lungs and heart of a patient.

So, it is clear why this type of drugs is usually prescribed to a patient with CTEPH or Chronic Thromboembolic Pulmonary Hypertension. It is effective in cases when surgery is not an option OR a patient requires additional treatment after a surgery. CTEPH, however, is not the only condition riociguat is for. It also treats those adults with PAH – Pulmonary Arterial Hypertension. In the latter case, the drug can be used either on its own or when combined with other meds. And, frankly speaking, when doses are adjusted, Levitra can become that combination option.


FYI, CTEPH is a very rare condition that is provoked by the occurrence of new blood clots on the lung blood vessels. The clots grow in number and block the flow of blood. When the flow is insufficient, the pressure grows and serious complications are inevitable. As to PAH, it is triggered by the narrowing of the lung’s blood vessels that eventually leads to the increased blood pressure as well. If any of these conditions takes place, a person feels really tired and dizzy.

Can a healthcare professional suggest riociguat for conditions other than the mentioned ones? He surely can. But any use and dose should be discussed with a healthcare professional. Besides, it is forbidden to share the drug with anyone even if his symptoms are very much alike.

Riociguat Contraindications

Riociguat is a potent drug, so its combination with any other medications should be supervised. When taking riociguat and other pills without having dose adjusted, a patient may experience very severe side effects that require immediate medical help. Hospitalization is no exception.

The use of riociguat with other medications that usually influence the (NO-sGC-cGMP) – nitric oxidesoluble guanylate cyclase- cyclic guanosine monophosphate pathway is contraindicated. Why? There are high risks of developing a life-threatening condition of syncope or hypotension. What drugs belong to the group of NO-sGC-cGMP?

They are:

  1. Nitrates that are administered either on a regular basis or intermittently. The effect doesn’t depend on their form (by inhalation, oral or sublingual);
  2. Nitric oxide donors (e.g. amyl nitrite);
  3. PDE-5 inhibitors (phosphodiesterase inhibitors like Vardenafil, Sildenafil, and Tadalafil).

We’d like to pay special attention to the use of Levitra along with riociguat: it leads to adverse reactions that require hospitalization as both medications relax and dilate the blood vessels. A male on impotence treatment pills should have his riociguat dose adjusted and vice versa.

Levitra + Riociguat: Side Effects

The reported side effects are no longer mild as after Levitra administration. They tend to turn into severe complications to be treated by healthcare professionals only.

So, let’s see what should be expected, if doses aren’t adjusted:

  • Dizziness;
  • Breathing problems;
  • Various allergic reactions including swelling of some body parts (usually lips, tongue or face);
  • Hives, skin rash and/or itching;
  • Feeling lightheaded/faint;
  • Chest pain;
  • Severe headache;
  • Uncommon diarrhea;
  • Unusual bruising;
  • Bleeding;
  • Nausea and/or vomiting;
  • Swelling of hands, feet and/or ankles.

It is proven that the very first complications occur during the first hour after administration. Headaches are typical for 18-27% of males, dizziness occurs in around 13-20% of users, dyspepsia is common for 8-16% of patients and nausea becomes the very first symptom in 11-14% of men. Other conditions are less common. For example, hypotension is experienced by 4-8% of men, anemia – by 2-7% of them, constipation – by 1-5% and gastro esophageal reflux disease – by 2-5%.

Some rare complications are abdominal distension and dysphagia, peripheral edema and palpations, epistaxis and nasal congestion.

Read also about side effects of Levitra

Levitra + Riociguat: Combination Studies

The medical ground: PHA is a serious condition that progresses pretty quickly. It’s the progress in pulmonary vascular resistance that often leads to RVH – right ventricular hypertrophy, failure and lethal outcome, the condition was the main focus of the study. The aim was to learn the effects of sGC stimulation by PDE-5 inhibitors and riociguat on RV remodeling in PAH.

Methods used: it’s not males but mice that were tested during the study. They were kept under the HOV and NOX conditions (hypoxic and normoxic respectively) during five weeks. Their daily treatment included 100 mg/kg/d of Vardenafil via drinking water and 30 mg/kg/d or riociguat via oral gavage. At the final stage, all the echocardiographic parameters were evaluated. The evaluation was performed with a Vevo-770 high resolution imaging system. The system is equipped with 25-MHz transducer. It measured:

  • RVID – right ventricular internal diameter;
  • CO – cardiac output;
  • TAPSE – tricuspid annular plane systolic excursion;
  • IVRT – RV isovolumic relaxation time;
  • MPI – myocardial performance index.

Results of the study: the results showed that both drugs have succeeded in the reduction of RV dilation as well as in the increase of CO. The compounds have improved tricuspid annular plane systolic excursion along with RV isovolumic relaxation time significantly. Besides, the RV MPI (the combination of systolic and diastolic parameters of RV function that is used as the RV global function marker) was improved as well in response to both medications.

It proves that medications like Levitra and riociguat can improve the RV function directly. Though, only mice were tested, some male sufferers are already offered to start combining the adjusted doses. However, there are only several cases of this sort of prescription, which means that no human results are available yet.

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