Drug & supplement interaction

Goji + Macitentan, Tadalafil

Macitentan, Tadalafil brand name: Opsynvi.

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

Macitentan, Tadalafil falls into 3 drug categories that Goji can interact with; the most serious is rated moderate. Theoretically, concomitant use of goji root bark, but not goji fruit, with antihypertensive drugs might have additive effects.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Goji and Macitentan, Tadalafil

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

Why Are There 3 Interactions?

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

Moderate

ANTIHYPERTENSIVE DRUGS

1 of 3

Why this applies to Macitentan, Tadalafil

Macitentan, Tadalafil falls under ANTIHYPERTENSIVE DRUGS — the group Goji interacts with.

Theoretically, concomitant use of goji root bark, but not goji fruit, with antihypertensive drugs might have additive effects.
Animal and in vitro research suggest that goji root bark has hypotensive effects. However, goji fruit juice does not appear to reduce systolic or diastolic blood pressure 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 that lower blood pressure in the lungs: macitentan (which relaxes blood vessels) and tadalafil (the same drug found in Cialis). Both can already drop your blood pressure. The concern here is very specific: goji root bark may add a mild blood-pressure-lowering effect on top of your medication. In theory, stacking those together could leave you feeling lightheaded, dizzy, faint when standing up, or unusually tired.

Here is the reassuring part. This is a theoretical flag based only on animal and lab studies, and it involves goji root bark, not the everyday goji fruit or juice most people eat. Goji fruit juice did not lower blood pressure in human studies. So snacking on the berries is very unlikely to matter. If you are considering a concentrated goji or root-bark supplement, check with your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Huang KC. The Pharmacology of Chinese Herbs. 2nd ed. Boca Raton, FL: CRC Press, LLC 1999.
  2. Amagase H, Nance DM. A randomized, double-blind, placebo-controlled, clinical study of the general effects of a standardized Lycium barbarum (goji) juice, GoChi. J Altern Complement Med 2008;14:403-12.
  3. Potterat O. Goji (Lycium barbarum and L. chinense): Phytochemistry, pharmacology and safety in the perspective of traditional uses and recent popularity. Planta Med 2010;76(1):7-19.
Moderate

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

2 of 3

Macitentan, Tadalafil also falls under CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES.

Theoretically, goji berry might inhibit CYP2C9 and reduce metabolism of CYP2C9 substrates.
In vitro research shows that goji berry tincture and juice inhibit CYP2C9 enzymes. Additionally, multiple case reports suggest that goji berry concentrated tea and juice inhibit the metabolism of warfarin, a CYP2C9 substrate. Concomitant use with goji may decrease metabolism and increase levels of CYP2C9 substrates.
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

Here's the gist with Opsynvi (which combines macitentan and tadalafil): goji berry, mainly as concentrated teas or juices, may gently block a liver enzyme called CYP2C9 that helps clear these medicines. If that clearance slows down, the drugs can build up a bit and their effects get stronger. For tadalafil, that could mean more headache, flushing, stuffy nose, low blood pressure, or dizziness. Macitentan can add to that blood-pressure lowering too.

Honestly, this is a theoretical concern based on lab studies and warfarin case reports, not solid human data on Opsynvi. Eating a normal amount of goji berries is unlikely to be a problem. Before adding a concentrated goji supplement, just run it by your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Lam AY, Elmer GW, Mohutsky MA. Possible interaction between warfarin and Lycium Barbarum. Ann Pharmacother 2001;35:1199-201.
  2. Guzmán CE, Guzmán-Moreno CG, Assad-Morell JL, Edgar Francisco Carrizales-Sepúlveda EF. Flecainide toxicity associated with the use of goji berries: a case report. Eur Heart J Case Rep. 2021;5(6):ytab204. PubMed
  3. Liu R, Tam TW, Mao J, et al. In vitro activity of Lycium barbarum (Goji) against major human phase I metabolism enzymes. Complement Integr Med. 2016;13(3):257-265.
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

3 of 3

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

Theoretically, goji berry might inhibit CYP3A4 and reduce metabolism of CYP3A4 substrates.
In vitro research shows that goji berry juice inhibits CYP3A4 enzymes. Concomitant use with goji may decrease metabolism and increase levels of CYP3A4 substrates. However, 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 largely by a liver enzyme called CYP3A4. In lab studies, goji berry juice appeared to slow that enzyme down. If it did the same in people, your body might clear these drugs a little slower, letting levels drift up. With tadalafil that could mean more headache, flushing, stuffy nose, upset stomach, or lightheadedness (especially standing up), and with macitentan possibly more swelling or low blood pressure.

Here's the reassuring part: this is only test-tube evidence and has never been reported in real patients. Eating goji berries as food is unlikely to matter much. Still, concentrated goji supplements are worth running past your pharmacist or doctor first, since blood pressure control matters here.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Liu R, Tam TW, Mao J, et al. In vitro activity of Lycium barbarum (Goji) against major human phase I metabolism enzymes. Complement Integr Med. 2016;13(3):257-265.

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

Goji Also Interacts With Other Medications

Goji has 2 major, 929 moderate, 68 minor 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 2 Moderate 929 Minor 68 No known interaction 1,831 (incl. Macitentan, Tadalafil)
Taking anything else?

Check Another of Your Medications Against Goji

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

Everything else you take

See Every Supplement That Interacts With Macitentan, Tadalafil

This page covers Goji 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 Goji as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1,738 real supplement products containing Goji, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Goji. Your product may carry other ingredients that interact with Macitentan, Tadalafil too, on top of Goji — 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 Goji 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 Goji
Top 25%

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

29 days ago today
Medication Macitentan, Tadalafil
Top half

#1,170 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 Goji

What is Goji?

Goji
  • General antioxidant support
  • Eye health
  • Immune support
  • Anti-aging and well-being
  • Blood sugar support

Goji berries are a nutritious fruit rich in antioxidants, vitamins, and plant polysaccharides, and they are safe for most people as a food. While they are popular for eye health, immune support, and general wellness, strong human evidence for most health claims is limited. Talk with your pharmacist or doctor before using concentrated goji supplements, especially if you take medications or are pregnant.

Read the full Goji monograph & all interactions
Keep checking

Other Drugs & Goji

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

2Major
929Moderate
68Minor
1,830No known interaction
2 Major 929 Moderate 68 Minor 1,830 No interaction
Major

2 interactions

Moderate

929 interactions

Showing 60 of 929 moderate interactions — see all 929 on the Goji page.

Minor

68 interactions

Showing 60 of 68 minor interactions — see all 68 on the Goji page.

No interaction 1,830 drugs checked — show the list

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

Showing the 60 most looked-up of 1,830 medications checked with no known interaction — see the full Goji list.

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

Can you take Goji 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 3 interactions listed for Goji and Macitentan, Tadalafil?
Macitentan, Tadalafil belongs to more than one drug category, and Goji 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 Goji 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

Still Have a Question About Macitentan, Tadalafil and Goji?

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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.