Goldenseal + Macitentan, Tadalafil
Macitentan, Tadalafil brand name: Opsynvi.
Macitentan, Tadalafil falls into 3 drug categories that Goldenseal can interact with; the most serious is rated moderate. Theoretically, goldenseal might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full interaction reportGoldenseal and Macitentan, Tadalafil
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Goldenseal interacts with whole categories of medication. Macitentan, Tadalafil falls into 3 of those categories, so it can interact with Goldenseal in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
ANTIHYPERTENSIVE DRUGS
1 of 3Why this applies to Macitentan, Tadalafil
Macitentan, Tadalafil falls under ANTIHYPERTENSIVE DRUGS — the group Goldenseal interacts with.
Goldenseal contains berberine. Animal research shows that berberine can have hypotensive effects. Also, an analysis of clinical research shows that taking berberine in combination with amlodipine can lower systolic and diastolic blood pressure when compared with amlodipine alone. However, this effect has not been reported with goldenseal.
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.
Opsynvi combines two medicines that lower blood pressure in the lungs, and both can nudge your overall blood pressure downward too. Here's the concern with goldenseal: it contains berberine, which in animal studies (and in one human study alongside amlodipine) showed a modest blood pressure lowering effect. Stacked on top of macitentan and tadalafil, that could theoretically add up and leave you a bit too low.
If your blood pressure dips too far, you might feel dizzy, lightheaded, faint, or unusually flushed or tired, especially when standing up. That said, this is a theoretical interaction based on how berberine behaves, not something proven with goldenseal itself. Please don't change anything on your own. Just loop in your pharmacist or doctor before adding goldenseal so they can keep an eye on your readings.
- Sabir M and Bhide NK. Study of some pharmacological actions of berberine. Ind J Physiol & Pharmac 1971;15(3):111-132.
- Chun YT, Yip TT, Lau KL, and et al. A biochemical study on the hypotensive effect of berberine in rats. Gen Pharmac 1979;10:177-182. PubMed
- Lan J, Zhao Y, Dong F, et al. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. J Ethnopharmacol. 2015;161:69-81. PubMed
CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES
2 of 3Macitentan, Tadalafil also falls under CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES.
In vitro research shows that goldenseal root extract can modestly inhibit CYP2C9. This effect may be due to its alkaloid constituents, hydrastine and berberine. However, this effect has not been reported in humans.
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.
Opsynvi combines two blood pressure medicines for pulmonary hypertension: macitentan and tadalafil. Both are handled in part by a liver enzyme called CYP2C9. Goldenseal may gently slow that enzyme down, so in theory the medicine could clear a little slower and build up in your blood. If that happened, you might notice more of tadalafil's usual effects, like headache, flushing, stuffy nose, indigestion, or dizziness from your blood pressure dropping too far.
Here's the reassuring part: this concern comes only from lab (test tube) studies, and it has not been shown in real people. Neither drug is a prodrug, so goldenseal would not weaken them. Still, since Opsynvi affects blood pressure, it's worth a quick chat with your pharmacist or doctor before adding goldenseal.
- Chatterjee P, Franklin MR. Human cytochrome p450 inhibition and metabolic-intermediate complex formation by goldenseal extract and its methylenedioxyphenyl components. Drug Metab Dispos 2003;31:1391-7. PubMed
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
3 of 3Macitentan, Tadalafil also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
Most clinical and in vitro research shows that goldenseal inhibits CYP3A4 enzyme activity and increases serum levels of CYP3A4 substrates, such as midazolam. However, in one small clinical study, goldenseal did not affect the levels of indinavir, a CYP3A4 substrate, in healthy volunteers. This is likely due to the fact that indinavir has a high oral bioavailability, making it an inadequate probe for CYP3A4 interactions and/or that it is primarily metabolized by hepatic CYP3A, while goldenseal has more potential to inhibit intestinal CYP3A enzyme activity. Both goldenseal extract and its isolated constituents berberine and hydrastine inhibit CYP3A, with hydrastine possibly having more inhibitory potential than berberine.
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.
Opsynvi combines two medicines, macitentan and tadalafil, and both are cleared largely by a liver and gut enzyme called CYP3A4. Goldenseal tends to slow that enzyme down. When that happens, these drugs can hang around in your body longer than intended and their levels can creep up.
In real terms, that could mean more of the effects you already know from this combo pill, especially the blood-pressure lowering. Think dizziness, lightheadedness, flushing, headache, a stuffy nose, or a faster heartbeat. This is based on decent (though not huge) human research, so I would not panic, but I would not mix them casually either. Please check with your pharmacist or doctor before adding goldenseal. Do not start or stop anything on your own.
- Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. PubMed
- Sandhu RS, Prescilla RP, Simonelli TM, Edwards DJ. Influence of goldenseal root on the pharmacokinetics of indinavir. J Clin Pharmacol 2003;43:1283-8.. PubMed
- Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. PubMed
- Chatterjee P, Franklin MR. Human cytochrome p450 inhibition and metabolic-intermediate complex formation by goldenseal extract and its methylenedioxyphenyl components. Drug Metab Dispos 2003;31:1391-7. PubMed
- Gurley BJ, et al. Supplementation with goldenseal (Hydrastis canadensis), but not kava kava (Piper methysticum), inhibits human CYP3A activitiy In Vivo. Clin Pharmacol Ther. 2008;83(1):61-69.
- Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. PubMed
- Nguyen JT, Tian DD, Tanna RS, et al. An Integrative Approach to Elucidate Mechanisms Underlying the Pharmacokinetic Goldenseal-Midazolam Interaction: Application of In Vitro Assays and Physiologically Based Pharmacokinetic Models to Understand Clinical Ob
What These Ratings Mean
Every interaction above is graded three ways — here’s the key to each label.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- 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.
- 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.
Goldenseal Also Interacts With Other Medications
Goldenseal has 1,235 moderate, 1 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.
Check Another of Your Medications Against Goldenseal
We haven’t checked that one against Goldenseal yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Goldenseal. Pick one to open its full report.
See Every Supplement That Interacts With Macitentan, Tadalafil
This page covers Goldenseal 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
Taking Goldenseal as Part of a Dietary Supplement Product? Check It for Interactions
We hold 1,726 real supplement products containing Goldenseal, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Goldenseal. Your product may carry other ingredients that interact with Macitentan, Tadalafil too, on top of Goldenseal — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Goldenseal 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.
#115 of 1,452 supplements looked up here in the last 7 days
#393 of 2,830 medications looked up here in the last 7 days
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.
About Goldenseal
What is Goldenseal?
- Digestive upset and diarrhea
- Colds and respiratory infections
- Sore throat and mouth sores
- Skin and eye irritation (topical/traditional)
- Antimicrobial support
Goldenseal is a popular North American herb that contains berberine, a compound studied for antimicrobial effects. However, strong human evidence for its many traditional uses is largely lacking, and it should be avoided during pregnancy and breastfeeding. Talk to a pharmacist or doctor before using it.
Other Drugs & Goldenseal
Browse every other medication we’ve checked against Goldenseal — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1,235 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Diphenhydramine ›
- Aspirin ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Doxycycline ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Tetracycline ›
- Lidocaine ›
- Ranitidine ›
- Guaifenesin ›
- Hydrochlorothiazide ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Insulin (pork) ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Triamcinolone ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Hydralazine ›
- Indomethacin ›
- Insulin (human) ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Trimipramine ›
- Acetaminophen ›
Showing 60 of 1,235 moderate interactions — see all 1,235 on the Goldenseal page.
1 interaction
No interaction 1,593 drugs checked — show the list
We also checked Goldenseal against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Rosuvastatin ›
- Escitalopram ›
- Isotretinoin ›
- Docusate ›
- Hydroxyurea ›
- Valacyclovir ›
- Sumatriptan ›
- Levothyroxine, Liothyronine ›
- Methotrexate ›
- Amoxicillin ›
- Bupropion ›
- Azithromycin ›
- Bendamustine ›
- Acyclovir ›
- Methylene Blue ›
- Ciprofloxacin ›
- Amoxicillin, Clavulanate Potassium ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Ezetimibe ›
- Isoniazid, Pyrazinamide, Rifampin ›
- Cyclopentolate ›
- Cephalexin ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Levodopa ›
- Roxithromycin ›
- Ceftolozane Sulfate, Tazobactam Sodium ›
- Alginic Acid, Aluminum Hydroxide ›
- Mitomycin ›
- Flutemetamol F-18 ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Levothyroxine Sodium ›
- Efgartigimod Alfa-fcab ›
- Charcoal (otc Drug) ›
- Magnesium Hydroxide (otc Drug) ›
- Atropine Methyl Nitrate, Digestive Enzymes ›
- Daunorubicin, Cytarabine ›
- Peginterferon Alfa-2a, Ribavirin ›
- Articaine, Epinephrine ›
- Aminolevulinic Acid Hydrochloride ›
- Alpha-1 Proteinase Inhibitor ›
- Sodium Bicarbonate (otc Drug) ›
- Cytomegalovirus Immune Globulin ›
- Cefaclor ›
- Dexmethylphenidate ›
- Tubocurarine ›
- Bismuth Subcarbonate, Calcium Carbonate, Opium ›
- Imipenem, Cilastatin, Relebactam ›
- Hydroxychloroquine ›
- Daptomycin ›
- Pyrilamine Maleate ›
- Ephedrine, Hydroxyzine, Theophylline ›
- Dihydroxyaluminum Sodium Carbonate ›
- Colistin, Neomycin, Hydrocortisone ›
- Rosuvastatin Calcium, Ezetimibe ›
- Carbinoxamine Maleate ›
- Ephedrine Sulfate, Hydroxyzine, Theophylline ›
- Lonapegsomatropin-tcgd ›
Showing the 60 most looked-up of 1,593 medications checked with no known interaction — see the full Goldenseal list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
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
Macitentan, Tadalafil Is Linked to Lower Levels of One Nutrient
Natural Medicines records Macitentan, Tadalafil as a medicine that can lower these. This is not an interaction with Goldenseal — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Macitentan, Tadalafil nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Goldenseal and Macitentan, Tadalafil Together: Common Questions
Can you take Goldenseal with Macitentan, Tadalafil?
Why are there 3 interactions listed for Goldenseal and Macitentan, Tadalafil?
How serious is the Goldenseal and Macitentan, Tadalafil interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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