Drug & supplement interaction

Nicotinamide Riboside + Macitentan

Macitentan brand name: Opsumit.

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

Nicotinamide Riboside has a minor interaction with Macitentan. Theoretically, nicotinamide riboside may have additive effects with antihypertensive drugs, potentially increasing the risk for hypotension.

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

Nicotinamide Riboside and Macitentan

Here is the interaction we found between these two, with the evidence behind it.

Minor

ANTIHYPERTENSIVE DRUGS

Why this applies to Macitentan

Macitentan falls under ANTIHYPERTENSIVE DRUGS — the group Nicotinamide Riboside interacts with.

Theoretically, nicotinamide riboside may have additive effects with antihypertensive drugs, potentially increasing the risk for hypotension.
One small clinical study suggests that nicotinamide riboside can modestly reduce blood pressure in hypertensive patients. However, other clinical research did not find a reduction in blood pressure when compared with control.
Severity Minor 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 macitentan (Opsumit) and nicotinamide riboside. Macitentan already works to relax and open up blood vessels in your lungs, which can also nudge your overall blood pressure down. The thought here is that NR might, in some people, lower blood pressure a little too. Stack the two and in theory you could see slightly more of a dip than expected.

I want to be honest: this is a theoretical concern based on how things work, and the human data is mixed. One small study saw a modest blood pressure drop with NR, others saw nothing. So this is rated minor. If you do start NR, just keep an eye out for lightheadedness, dizziness, or feeling faint when you stand, and loop in your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Martens CR, Denman BA, Mazzo MR, et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun 2018;9(1):1286. PubMed
  2. Remie CME, Roumans KHM, Moonen MPB, et al. Nicotinamide riboside supplementation alters body composition and skeletal muscle acetylcarnitine concentrations in healthy obese humans. Am J Clin Nutr. 2020;112(2):413-426. 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

Nicotinamide Riboside Also Interacts With Other Medications

Nicotinamide Riboside has 171 minor known drug interactions in our database — the Macitentan one above is one of them. If you take anything else, check it against the full list below.

Minor 171 No known interaction 2,659 (incl. Macitentan)
Taking anything else?

Check Another of Your Medications Against Nicotinamide Riboside

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

Everything else you take

See Every Supplement That Interacts With Macitentan

This page covers Nicotinamide Riboside only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Macitentan page lists 253 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: 9 major · 205 moderate · 39 minor.

From our pharmacist’s overview on the Macitentan page

“If you take macitentan (Opsumit) for pulmonary arterial hypertension, study this page rather than skim it. It lists 253 supplement and herbal ingredients, nine rated major.”

Reviewed by 2 · Jul 18, 2026

Open the Macitentan interaction page

One more smart check

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

We hold 162 real supplement products containing Nicotinamide Riboside, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Nicotinamide Riboside. Your product may carry other ingredients that interact with Macitentan too, on top of Nicotinamide Riboside — 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 Nicotinamide Riboside and Macitentan 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 Nicotinamide Riboside
Top half

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

29 days ago today
Medication Macitentan
Top 5%

#89 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 Nicotinamide Riboside

What is Nicotinamide Riboside?

  • Healthy aging
  • Boosting cellular energy
  • Supporting metabolism
  • General wellness
  • Athletic recovery

Nicotinamide riboside (NR) is a form of vitamin B3 that the body converts into NAD+, a molecule involved in cellular energy and repair. Early human studies show it can reliably raise NAD+ levels and appears generally well tolerated, but solid evidence that it improves aging, energy, or specific health conditions is still limited. Talk with your pharmacist or doctor before starting it.

Read the full Nicotinamide Riboside monograph & all interactions
Medication

About Macitentan

What Is Macitentan Used For?

Brand name: Opsumit

Macitentan tablets — sold under the brand name Opsumit — are used to treat pulmonary arterial hypertension (PAH, WHO Group I), a serious condition where the blood pressure in the arteries supplying the lungs is abnormally high. The goal is to slow down how quickly the disease gets worse and to lower the chances of being hospitalized because of it.

In clinical studies, it was shown to be effective in adults with mostly moderate-to-severe PAH symptoms. Patients in those studies had PAH caused by unknown or inherited reasons, connective tissue disorders, or congenital heart disease with repaired heart shunts.

See full Macitentan drug information
Keep checking

Other Drugs & Nicotinamide Riboside

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

0Major
0Moderate
171Minor
2,658No known interaction
171 Minor 2,658 No interaction
Minor

171 interactions

Showing 60 of 171 minor interactions — see all 171 on the Nicotinamide Riboside page.

No interaction 2,658 drugs checked — show the list

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

Showing the 60 most looked-up of 2,658 medications checked with no known interaction — see the full Nicotinamide Riboside list.

See the full Nicotinamide Riboside interactions page
See every supplement checked against Macitentan, 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
Nicotinamide Riboside monograph › Uses, safety, and every drug interaction in one place Macitentan supplement interactions › Every supplement checked against Macitentan, ranked by severity Macitentan drug information › The full plain-English guide to this medication 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 Nicotinamide Riboside and Macitentan Together: Common Questions

Can you take Nicotinamide Riboside with Macitentan?
There is only a minor interaction, which is usually not serious. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Nicotinamide Riboside and Macitentan interaction?
We rate it Minor. This interaction is generally not clinically significant, but it remains worth noting and discussing with your pharmacist.

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

Still Have a Question About Macitentan and Nicotinamide Riboside?

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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.