Drug & supplement interaction

Eucalyptus + Macitentan, Tadalafil

Macitentan, Tadalafil brand name: Opsynvi.

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

Macitentan, Tadalafil falls into 2 drug categories that Eucalyptus can interact with; the most serious is rated moderate. Theoretically, eucalyptus might increase the levels of CYP2C9 substrates.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Eucalyptus and Macitentan, Tadalafil

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Eucalyptus interacts with whole categories of medication. Macitentan, Tadalafil falls into 2 of those categories, so it can interact with Eucalyptus in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

1 of 2

Why this applies to Macitentan, Tadalafil

Macitentan, Tadalafil falls under CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES — the group Eucalyptus interacts with.

Theoretically, eucalyptus might increase the levels of CYP2C9 substrates.
In vitro research suggests that eucalyptus oil might inhibit CYP2C9, although this has not been reported in humans.
Severity Moderate Likelihood Possible Evidence D

Interaction 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.

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

Opsynvi combines two blood pressure medicines used for pulmonary arterial hypertension, and part of the tadalafil is cleared by a liver enzyme called CYP2C9. The idea here is that eucalyptus oil might slow that enzyme down a little. If it did, your body could hold onto more of the drug, which in theory could bump up side effects like headache, flushing, dizziness, low blood pressure, an upset stomach, or muscle aches.

Here is the important part: this comes only from lab testing, not from people, so it is very much a theoretical concern. Everyday use of vapor rubs, lozenges, or inhalers is unlikely to cause trouble. Never swallow eucalyptus oil, and check with your pharmacist or doctor before using concentrated eucalyptus products.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom 2004;1 PubMed
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 2

Macitentan, Tadalafil also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Theoretically, eucalyptus might increase the levels of CYP3A4 substrates.
In vitro research suggests that eucalyptus oil might inhibit CYP3A4, although this has not been reported in humans.
Severity Moderate Likelihood Possible Evidence D

Interaction 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.

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

Opsynvi combines two medicines, macitentan and tadalafil, and both are cleared from your body by a liver enzyme called CYP3A4. In the lab, eucalyptus oil appears to slow that enzyme down a bit. If that happened in real life, it could let these drugs build up slightly. For tadalafil that might mean more headache, flushing, stuffy nose, or low blood pressure with dizziness. For macitentan, higher levels could add to side effects like fluid retention or feeling wiped out.

Here is the reassuring part: this is only a theoretical, test-tube finding and has never been shown in people. Breathing in eucalyptus vapor or using a lozenge is very unlikely to matter. Still, since Opsynvi is a serious heart and lung medicine, check with your pharmacist before taking any concentrated eucalyptus product by mouth.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom 2004;1 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

Eucalyptus Also Interacts With Other Medications

Eucalyptus has 877 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.

Moderate 877 No known interaction 1,953 (incl. Macitentan, Tadalafil)
Taking anything else?

Check Another of Your Medications Against Eucalyptus

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

Everything else you take

See Every Supplement That Interacts With Macitentan, Tadalafil

This page covers Eucalyptus 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), Beer (major) and Grapefruit (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

One more smart check

Taking Eucalyptus as Part of a Dietary Supplement Product? Check It for Interactions

We hold 216 real supplement products containing Eucalyptus, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Eucalyptus. Your product may carry other ingredients that interact with Macitentan, Tadalafil too, on top of Eucalyptus — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Eucalyptus 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 Eucalyptus
Top half

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

29 days ago today
Medication Macitentan, Tadalafil
Top half

#1,331 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 Eucalyptus

What is Eucalyptus?

Eucalyptus
  • Cough and chest congestion
  • Colds and flu symptoms
  • Stuffy nose
  • Sore throat
  • Minor muscle and joint aches
  • Aromatherapy

Eucalyptus is best known for its strong-smelling oil used in vapor rubs, inhalants, and lozenges to ease coughs and congestion. It may provide mild, short-term relief of cold symptoms, but the oil is toxic if swallowed and must never be taken by mouth undiluted. Talk to a pharmacist or doctor before using it, especially in children, during pregnancy, or while breastfeeding.

Read the full Eucalyptus monograph & all interactions
Keep checking

Other Drugs & Eucalyptus

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

0Major
877Moderate
0Minor
1,952No known interaction
877 Moderate 1,952 No interaction
Moderate

877 interactions

Showing 60 of 877 moderate interactions — see all 877 on the Eucalyptus page.

No interaction 1,952 drugs checked — show the list

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

Showing the 60 most looked-up of 1,952 medications checked with no known interaction — see the full Eucalyptus list.

See the full Eucalyptus 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
Eucalyptus 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 Eucalyptus and Macitentan, Tadalafil Together: Common Questions

Can you take Eucalyptus with Macitentan, Tadalafil?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Eucalyptus and Macitentan, Tadalafil?
Macitentan, Tadalafil belongs to more than one drug category, and Eucalyptus 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 Eucalyptus and Macitentan, Tadalafil interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

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.