Drug & supplement interaction

Wine + 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 Wine 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
EvidenceC
What do Severity, Likelihood & Evidence mean?
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Interaction report

Wine and Macitentan, Tadalafil

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

Why Are There 3 Interactions?

Wine interacts with whole categories of medication. Macitentan, Tadalafil falls into 3 of those categories, so it can interact with Wine 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 Wine 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 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 medicines, macitentan and tadalafil, that you take for pulmonary arterial hypertension. Here's the piece to pay attention to: macitentan (like other drugs in its class) can put stress on the liver, and drinking alcohol adds to that strain. When you regularly drink heavier amounts of wine on top of this medication, you raise the chance of liver irritation or damage stacking up over time.

This isn't about one glass on a special occasion, it's the ongoing or excessive drinking that worries us most. There's also a separate point worth knowing: both alcohol and tadalafil can lower blood pressure, so mixing them may leave you feeling dizzy or lightheaded. Please check with your pharmacist or doctor about what, if any, amount 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
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 is a combination pill that opens up your blood vessels: macitentan relaxes the vessels in your lungs, and tadalafil (the same medicine in Cialis) does the same across your body. Both work by lowering the pressure in your blood vessels, so they naturally nudge your blood pressure down.

Here's the catch with wine. Alcohol is also a vasodilator, so drinking on top of Opsynvi can stack these effects and drop your blood pressure too far. That can leave you feeling dizzy, lightheaded, or faint, especially when you stand up quickly, and it may bring on a headache or flushing. A large amount of alcohol at once is the bigger worry, more so than a small sip. Please talk with your pharmacist or doctor about what's safe for you before mixing the two.

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 blood pressure lowering medicines: macitentan, which relaxes lung blood vessels, and tadalafil, the same drug found in Cialis. Both can drop your blood pressure, and adding wine into the mix can push things in unpredictable ways. A drink now and then can nudge blood pressure up over time, but drinking more than a little, especially all at once, can add to Opsynvi's effect and drop your pressure too low.

That can leave you feeling dizzy, lightheaded, flushed, or faint, particularly when you stand up quickly. If you want to enjoy an occasional glass, that's a reasonable thing to run by your pharmacist or doctor first, since they know your specific situation and how well your pressure is controlled.

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

Wine Also Interacts With Other Medications

Wine has 655 major, 270 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 655 Moderate 270 No known interaction 1,905 (incl. Macitentan, Tadalafil)
Taking anything else?

Check Another of Your Medications Against Wine

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

Everything else you take

See Every Supplement That Interacts With Macitentan, Tadalafil

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

We hold 8 real supplement products containing Wine, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Wine. Your product may carry other ingredients that interact with Macitentan, Tadalafil too, on top of Wine — 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 Wine 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 Wine
Top half

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

29 days ago today
Medication Macitentan, Tadalafil
Steady interest

#1,968 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 Wine

What is Wine?

  • Social and relaxation use
  • Heart health (popular belief)
  • Antioxidant intake
  • Aiding digestion (traditional use)
  • Culinary flavoring

Wine is an alcoholic beverage made from fermented grapes and is not a true dietary supplement or medicine. Despite popular claims about heart benefits, the alcohol it contains carries real health risks, and no amount of drinking can be recommended to improve health. If you drink, do so in moderation, and avoid alcohol entirely during pregnancy or if you have certain medical conditions.

Read the full Wine monograph & all interactions
Keep checking

Other Drugs & Wine

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

655Major
270Moderate
0Minor
1,904No known interaction
655 Major 270 Moderate 1,904 No interaction
Major

655 interactions

Showing 60 of 655 major interactions — see all 655 on the Wine page.

Moderate

270 interactions

Showing 60 of 270 moderate interactions — see all 270 on the Wine page.

No interaction 1,904 drugs checked — show the list

We also checked Wine 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 Wine list.

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

Can you take Wine 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 Wine and Macitentan, Tadalafil?
Macitentan, Tadalafil belongs to more than one drug category, and Wine 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 Wine 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

Still Have a Question About Macitentan, Tadalafil and Wine?

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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.