Medication interaction hub

What Supplements Interact with Macitentan?

Macitentan brand name: Opsumit. Every interaction below applies to the brands too.

253 Interactions 9 Major 205 Moderate 39 Minor
Curated & coded by · Clinical Pharmacist · Updated October 5, 2026

Drug–supplement interaction data sourced from Natural Medicines Pro, the licensed clinical database from TRC Healthcare / Therapeutic Research, with additional analysis by the HelloPharmacist Pharmacist Team. Our sources · Editorial policy

What is this page for?

One answer, for one medication: what supplements and herbal products interact with Macitentan? Every vitamin, herb, and supplement ingredient we’ve checked against it is on this page, ranked by severity, each linking to the full report for that exact pair.

This page covers supplement interactions only — to check Macitentan against your other medications, use the drug–drug interaction checker. Educational information from our licensed clinical databases, not medical advice. Our editorial policy

HelloPharmacist Bottom Line
Our Pharmacist Explains
What is this? The interaction data in the HelloPharmacist supplement database is licensed from Natural Medicines Pro by TRC Healthcare (Therapeutic Research). HelloPharmacist pharmacists often add our own analysis and context on top of that licensed data — such as this Bottom Line summary and the notes on individual interaction pages — and any such commentary is noted as ours.

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. Two problems dominate. More than a hundred entries can pile onto macitentan's blood-pressure-lowering effect and leave you dizzy or faint, and a similar number can change how the liver enzyme CYP3A4 clears the drug. Grapefruit pushes levels up, while St. John's wort can drain them enough to undercut your treatment.

Thirty-eight of these, alcohol among them, can stress the liver, which already has to process macitentan. Another 17 can block the tablet from absorbing, activated charcoal being the clearest example, so space those well apart from your dose. Know the nine majors first. The 205 moderate and 39 minor entries are mostly gentler versions of the same blood pressure and enzyme effects, worth a quick word with your pharmacist rather than an automatic no.

— , Clinical Pharmacist · July 18, 2026

Major 9 Moderate 205 Minor 39 No known interaction 1,199

This box checks one ingredient at a time (like turmeric or magnesium). Taking a supplement product with a whole label of ingredients? Search the product instead — we check every ingredient on it ↓

Top Ingredient Interactions

Macitentan: Top Interactions at a Glance

The most significant Macitentan supplement & herbal interactions, colored by severity. Tap any ingredient to open the full report for that pair.

Showing the 12 highest-ranked of 253 interacting ingredients — plus 1,199 more checked with no known interaction. See the complete ranked list.

Start here

The Major Interactions to Know About

The most clinically significant Macitentan + supplement combinations in our database, best-documented first. Open any card for the full report.

Major Likelihood Likely American Hellebore + Macitentani

American hellebore can have potent cardiovascular effects due to the toxic steroid ester alkaloids it contains.

Read the full interaction Major Likelihood Likely Grapefruit + Macitentani

Grapefruit juice can increase levels of drugs metabolized by CYP3A4.

Read the full interaction Major Likelihood Likely Siberian Cocklebur + Macitentani

Siberian cocklebur can adversely affect the liver.

Read the full interaction Major Likelihood Likely Tyramine + Macitentani

Tyramine may increase the risk of hypertension and reduce the effects of antihypertensive drugs.

Read the full interaction Major Likelihood Probable Activated Charcoal + Macitentani

Activated charcoal reduces systemic exposure to many drugs, including those that undergo enterohepatic recirculation, regardless of the route of administration.

Read the full interaction Major Likelihood Probable American Mistletoe + Macitentani

American mistletoe contains phoratoxin, a compound toxic to humans that induces smooth muscle contraction and vasoconstriction, potentially increasing blood pre...

Read the full interaction
The complete list

Every Supplement Checked Against Macitentan

All 1,452 ingredients in our database, ranked by severity — 253 with a Macitentan interaction on file and 1,199 with none found. Filter by severity or search any ingredient; hover the for what each ingredient is.

Looking for an interaction with a specific supplement product? Search products instead ↓

Straight answers

Can You Take It With Macitentan?

One-line answers, one card per combination — scroll through today’s 20 and tap any card for the full report. A different set rotates in daily until every combination has had its turn.

Can you take Fucus Vesiculosus with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, concomitant use of Fucus vesiculosus with CYP3A4 substrates might increase the risk for adverse effects.

Full Fucus Vesiculosus + Macitentan answer

Can you take Green Coffee with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, taking green coffee with antihypertensive drugs might increase the risk of hypotension.

Full Green Coffee + Macitentan answer

Can you take Hemp with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, hemp might decrease the levels and clinical effects of CYP3A4 substrates.

Full Hemp + Macitentan answer

Can you take Honey with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, honey might decrease levels of drugs metabolized by CYP3A4, but research is conflicting.

Full Honey + Macitentan answer

Can you take Hops with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, hops extract might alter metabolism of CYP3A4 substrates; however, this effect may not be clinically significant.

Full Hops + Macitentan answer

Can you take Humann Superbeets Heart Chews with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Each serving of HumanN SuperBeets includes 500mg of beetroot powder (2 chews).

Full Humann Superbeets Heart Chews + Macitentan answer

Can you take Karaya Gum with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Co-administration of oral drugs with bulk forming laxatives such as karaya gum may decrease, increase, or have no effect on the absorption o...

Full Karaya Gum + Macitentan answer

Can you take Marshmallow with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, mucilage in marshmallow might impair absorption of oral drugs.

Full Marshmallow + Macitentan answer

Can you take N-methyltyramine with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. In animal research, N-methyltyramine increased blood pressure.

Full N-methyltyramine + Macitentan answer

Can you take Nicotinamide Riboside with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, nicotinamide riboside may have additive effects with antihypertensive drugs, potentially increasing the risk for hypotension.

Full Nicotinamide Riboside + Macitentan answer

Can you take Passion Flower with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, passion flower might decrease the effects of CYP3A4 substrates.

Full Passion Flower + Macitentan answer

Can you take Puravive with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Puravive contains quercetin, which has been found to slightly reduce blood pressure in individuals with mild hypertension (https://pubmed.nc...

Full Puravive + Macitentan answer

Can you take Stevia with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, combining stevia or stevia constituents with antihypertensive agents might increase the risk of hypotension.

Full Stevia + Macitentan answer

Can you take Valerian with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Valerian does not seem to have a clinically relevant effect on levels of drugs metabolized by CYP3A4.

Full Valerian + Macitentan answer

Can you take Vitamin D with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Vitamin D might induce CYP3A4 enzymes and reduce the bioavailability of CYP3A4 substrates.

Full Vitamin D + Macitentan answer

Can you take Xanthan Gum with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, xanthan gum can alter the absorption of oral drugs due to its fiber qualities.

Full Xanthan Gum + Macitentan answer

Can you take Yerba Mate with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, yerba mate might increase the levels and clinical effects of CYP3A4 substrates.

Full Yerba Mate + Macitentan answer

Can you take Delta-9-tetrahydrocannabinol (thc) with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, THC may increase the levels and clinical effects of CYP3A4 substrates.

Full Delta-9-tetrahydrocannabinol (thc) + Macitentan answer

Can you take Eleuthero with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.

Full Eleuthero + Macitentan answer

Can you take Gymnema with Macitentan?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, gymnema might increase levels of drugs metabolized by CYP3A4.

Full Gymnema + Macitentan answer
Read the list like a pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. 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.
  • Possible. 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
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each entry links to a full report with the clinical detail, likelihood, evidence level, and citations for that exact combination.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

How Does Our Interaction Checker Work?

Behind every verdict on this page is a category system. Our source database doesn’t document supplement interactions drug-by-drug — it documents them against groups of medications that behave the same way (for example, “drugs processed by the CYP3A4 liver enzyme” or “blood-thinning medications”).

So the check works in three steps: (1) Macitentan is classified into the pharmacology categories it belongs to, (2) every supplement interaction documented against any of those categories is inherited by Macitentan, and (3) each ingredient keeps its own severity, likelihood, and evidence grades from the underlying record. That’s why one supplement can carry several records for one drug — it may interact through more than one category.

Macitentan sits in 4 interaction categories. Open any one to see what the group means:

Cytochrome P450 3A4 (Cyp3A4) Substrates 121 ingredients

A drug-metabolism group: these medications are processed by the named liver enzyme (a cytochrome P450). Supplements that speed this enzyme up or slow it down can lower or raise the medication's levels in your body.

121 of the supplement ingredients on this page reach Macitentan through this category.

Antihypertensive Drugs 119 ingredients

Blood-pressure-lowering medications. Supplements that lower (or raise) blood pressure can amplify or fight these drugs.

119 of the supplement ingredients on this page reach Macitentan through this category.

Hepatotoxic Drugs 38 ingredients

Medications with known liver considerations. Supplements that can stress the liver add to the load.

38 of the supplement ingredients on this page reach Macitentan through this category.

Oral Drugs 17 ingredients

A pharmacology grouping from our source database: medications in this group share a property that certain supplements are known to interact with, so an interaction documented for the group applies to every drug in it.

17 of the supplement ingredients on this page reach Macitentan through this category.

About Macitentan

Macitentan is an endothelin receptor antagonist tablet used to treat pulmonary arterial hypertension (PAH) in adults, reducing the risk of disease progression and hospitalization.

Generic name: Macitentan  ·  Brand name: Opsumit.

See the full Macitentan drug information

Related: does Macitentan deplete any nutrients?

Macitentan has 1 reported nutrient association in the research literature — see the Macitentan nutrient depletion report.

Check a real product

Take a Supplement Product? Check the Whole Bottle Against Macitentan

Most supplements are combination products — and the interaction may come from an ingredient you didn’t buy it for. Search any product below (or scan its label) and we’ll check every ingredient on it against Macitentan.

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Pharmacist Counseling Corner

Macitentan & Supplements: Common Questions

What supplements interact with Macitentan?
Our database currently documents 253 ingredients with a known Macitentan interaction (9 major, 205 moderate, 39 minor). The practical move: scan the major group first, then look up the exact supplements you take rather than reading all 253. The highest-ranked right now: American Hellebore, Grapefruit, Siberian Cocklebur.
Which Macitentan supplement interactions are the most serious?
The 9 major-rated combinations — led by American Hellebore, Grapefruit, Siberian Cocklebur, Tyramine and Activated Charcoal — deserve real caution: these are the ones generally best avoided, or used only with your prescriber watching. If you take any of them today, don't panic and don't stop anything abruptly — call your pharmacist first. Jump to the ranked list.
Can I take vitamins or supplements while on Macitentan?
Plenty of supplements coexist fine with Macitentan; a shorter list does not. Rather than memorizing it, check the specific ingredients on your labels — the ranked list above covers every one we've checked, and multi-ingredient products can be checked label-by-label with our scanner. Try the label scanner or the interaction checker.
Do brands like Opsumit have the same supplement interactions as Macitentan?
Yes — Opsumit all contain Macitentan, so everything on this page applies to them equally. Interactions belong to the active drug, never to the brand on the box; the same is true of generics.
Where do these interaction ratings come from?
Every rating comes from the Natural Medicines database — the same evidence-graded reference pharmacists and hospitals use — and each interaction carries three separate grades: severity (how bad it can be), likelihood (how well it's documented in studies and case reports), and an evidence level. Our pharmacists review the content; we never let an AI decide an interaction. See how to read the ratings and our editorial policy.
Does Macitentan deplete any vitamins or nutrients?
It might — Macitentan has 1 reported nutrient-depletion association in the research literature, which is a different question from interactions: instead of a supplement changing the drug, the drug may lower a nutrient over time. See the Macitentan nutrient depletion report for the specifics and what to discuss with your pharmacist.
What about Macitentan and my other medications?
This page covers Macitentan against supplements and herbal ingredients. Checking Macitentan against your other prescription or OTC medications is a different tool — our drug interaction checker covers that side. Head to the drug–drug interaction checker, or read the full Macitentan drug information.

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

Where next

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Sourcing

Where This Data Comes From — and Why You Can Trust It

🧪 Licensed clinical database

Every interaction verdict on this page comes from Natural Medicines Pro (TRC Healthcare / Therapeutic Research) — the same evidence-graded reference used by pharmacists and hospitals. We license this data directly; we do not scrape it, and no AI invents an interaction.

🧑‍⚕️ Pharmacist review

This page is curated and coded by , Clinical Pharmacist, with additional analysis by the HelloPharmacist Pharmacist Team. Editorial commentary is ours; the licensed interaction records are shown as sourced.

🔄 Kept current

Our interaction database refreshes on a weekly cycle, and this page re-checks the live database every time it’s rebuilt — what you see reflects the database as of October 5, 2026.

🔍 Full transparency

How every dataset on this site is sourced, licensed, and updated is documented publicly: our data sources · editorial policy · how we use AI.

Educational information, not medical advice. An interaction being on file does not mean it will happen to you — and absence of one is not proof of safety. Never start or stop a medication or supplement without talking to your pharmacist or doctor.