Drug & supplement interaction

Beer + Macitentan, Tadalafil

Macitentan, Tadalafil brand name: Opsynvi.

Major Interaction
Medically reviewed by · Updated September 2026
The bottom line Major

Macitentan, Tadalafil falls into 3 drug categories that Beer can interact with; the most serious is rated major. Concomitant use of alcohol with hepatotoxic drugs may increase the risk of hepatotoxicity.

Read the full interaction report
SeverityMajor
LikelihoodProbable
Interactions3
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Beer and Macitentan, Tadalafil

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Beer interacts with whole categories of medication. Macitentan, Tadalafil falls into 3 of those categories, so it can interact with Beer in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Major).

Major

HEPATOTOXIC DRUGS

1 of 3

Why this applies to Macitentan, Tadalafil

Macitentan, Tadalafil falls under HEPATOTOXIC DRUGS — the group Beer interacts with.

Concomitant use of alcohol with hepatotoxic drugs may increase the risk of hepatotoxicity.
Concomitant use of excessive amounts of alcohol with potentially hepatotoxic drugs can increase the risk of liver damage.
Severity Major Likelihood Probable Evidence B

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Opsynvi is a combination of two medicines, macitentan and tadalafil, used to treat pulmonary arterial hypertension. The macitentan part in particular can be tough on the liver, so your doctor may already check your liver enzymes with blood tests. Adding alcohol from beer puts extra strain on that same organ. Drinking heavily or often alongside this medicine may raise your risk of liver injury, which can show up as fatigue, nausea, belly pain on the upper right side, dark urine, or yellowing of the skin or eyes.

An occasional beer is not the same as regular or heavy drinking, but since this is a real concern with these drugs, please check with your doctor or pharmacist about what amount, if any, is safe for you.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Fraser AG. Pharmacokinetic interactions between alcohol and other drugs. Clin Pharmacokinet 1997;33:79-90. PubMed
  2. Thummel, K. E., Slattery, J. T., Ro, H., Chien, J. Y., Nelson, S. D., Lown, K. E., and Watkins, P. B. Ethanol and production of the hepatotoxic metabolite of acetaminophen in healthy adults. Clin Pharmacol Ther 2000;67(6):591-599. PubMed
Moderate

VASODILATORS

2 of 3

Macitentan, Tadalafil also falls under VASODILATORS.

Concomitant use may increase the risk of acute hypotension.
Acute alcohol intoxication can increase the risk of hypotension and additive effects with vasodilators.
Severity Moderate Likelihood Probable Evidence C

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Opsynvi combines two blood-vessel relaxers: macitentan and tadalafil. Both work by widening your blood vessels, which is exactly what you want for pulmonary hypertension, but it also naturally lowers your blood pressure a bit. Here's the catch with beer: alcohol relaxes your blood vessels too. Stack that on top of Opsynvi and the blood-pressure-lowering effects can add up.

What that feels like in real life is dizziness, lightheadedness, a pounding headache, flushing, or feeling faint, especially when you stand up quickly. A light beer now and then is less of a concern than drinking heavily, where the drop can be sharper. If you'd like to enjoy a beer, chat with your pharmacist or doctor first about what's safe for you.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Fraser AG. Pharmacokinetic interactions between alcohol and other drugs. Clin Pharmacokinet 1997;33:79-90. PubMed
Moderate

ANTIHYPERTENSIVE DRUGS

3 of 3

Macitentan, Tadalafil also falls under ANTIHYPERTENSIVE DRUGS.

Theoretically, concomitant use may interfere with blood pressure control.
Clinical research suggests that consumption of alcohol can increase both systolic and diastolic blood pressure. However, acute alcohol intoxication can also increase the risk of hypotension and additive effects with antihypertensive drugs.
Severity Moderate Likelihood Probable Evidence B

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Opsynvi combines two medicines that both lower blood pressure: macitentan and tadalafil. They work in the lungs and blood vessels to open things up and reduce pressure. Adding beer into the mix can pull your blood pressure in unpredictable directions. A larger drink or two can cause an added drop in pressure, leaving you dizzy, lightheaded, flushed, or even faint, especially when you stand up quickly. Over time, regular heavier drinking can actually raise blood pressure and work against your treatment.

This is based on moderate evidence, and an occasional small drink may be fine for some people. Still, because you are on a combination made to control pressure, please check with your doctor or pharmacist about what amount, if any, is safe for you.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Fraser AG. Pharmacokinetic interactions between alcohol and other drugs. Clin Pharmacokinet 1997;33:79-90. PubMed
  2. Zilkens, R. R., Burke, V., Hodgson, J. M., Barden, A., Beilin, L. J., and Puddey, I. B. Red wine and beer elevate blood pressure in normotensive men. Hypertension 2005;45(5):874-879. PubMed
  3. Potter, J. F., Watson, R. D., Skan, W., and Beevers, D. G. The pressor and metabolic effects of alcohol in normotensive subjects. Hypertension 1986;8(7):625-631. PubMed
  4. Puddey, I. B., Beilin, L. J., Vandongen, R., Rouse, I. L., and Rogers, P. Evidence for a direct effect of alcohol consumption on blood pressure in normotensive men. A randomized controlled trial. Hypertension 1985;7(5):707-713. PubMed
  5. Puddey, I. B., Beilin, L. J., Vandongen, R., and Rouse, I. L. A randomized controlled trial of the effect of alcohol consumption on blood pressure. Clin Exp Pharmacol Physiol 1985;12(3):257-261. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Beer Also Interacts With Other Medications

Beer has 653 major, 272 moderate known drug interactions in our database — the Macitentan, Tadalafil one above is among them. If you take anything else, check it against the full list below.

Major 653 Moderate 272 No known interaction 1,905 (incl. Macitentan, Tadalafil)
Taking anything else?

Check Another of Your Medications Against Beer

Covers the 2,830 medications we’ve checked against Beer. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Macitentan, Tadalafil

This page covers Beer only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Macitentan, Tadalafil page lists 264 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), American Mistletoe (major), Grapefruit (major) and Hawthorn (major).

By severity: 10 major · 215 moderate · 39 minor.

From our pharmacist’s overview on the Macitentan, Tadalafil page

“Opsynvi pairs macitentan and tadalafil to lower pressure in the lung arteries, so anything that drops blood pressure further or shifts how the body handles these drugs deserves genuine respect, and I would read this list carefully. Ten of the 264 ingredients rate major, and most of the rest fall into two camps: additive blood-pressure-…”

Reviewed by 2 · Jul 18, 2026

Open the Macitentan, Tadalafil interaction page

How much people look this up

Where Beer and Macitentan, Tadalafil Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Beer
Top 25%

#325 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Macitentan, Tadalafil
Top half

#1,293 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Beer

What is Beer?

Beer
  • Social and recreational drinking
  • Relaxation
  • Heart health (popular belief)
  • Bone health (popular belief)
  • Source of antioxidants and B vitamins

Beer is an alcoholic beverage that contains some minerals, B vitamins, and plant compounds from hops and grain, but it is not a health supplement. Any possible benefits come only from light-to-moderate intake, and they are easily outweighed by the well-known harms of alcohol. The safest amount of alcohol for health is none, and beer should be avoided in pregnancy and breastfeeding.

Read the full Beer monograph & all interactions
Keep checking

Other Drugs & Beer

Browse every other medication we’ve checked against Beer — both the ones with a known interaction and the ones without. Select any drug for the full detail.

653Major
272Moderate
0Minor
1,904No known interaction
653 Major 272 Moderate 1,904 No interaction
Major

653 interactions

Showing 60 of 653 major interactions — see all 653 on the Beer page.

Moderate

272 interactions

Showing 60 of 272 moderate interactions — see all 272 on the Beer page.

No interaction 1,904 drugs checked — show the list

We also checked Beer against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,904 medications checked with no known interaction — see the full Beer list.

See the full Beer interactions page
See every supplement checked against Macitentan, Tadalafil, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Beer monograph › Uses, safety, and every drug interaction in one place Macitentan, Tadalafil supplement interactions › Every supplement checked against Macitentan, Tadalafil, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Beer and Macitentan, Tadalafil Together: Common Questions

Can you take Beer with Macitentan, Tadalafil?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 3 interactions listed for Beer and Macitentan, Tadalafil?
Macitentan, Tadalafil belongs to more than one drug category, and Beer interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Beer and Macitentan, Tadalafil interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.