Medication interaction hub

What Supplements Interact with Macitentan, Tadalafil?

Macitentan, Tadalafil brand name: Opsynvi. Every interaction below applies to the brands too.

264 Interactions 10 Major 215 Moderate 39 Minor
Curated & coded by · Clinical Pharmacist · Updated September 25, 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, Tadalafil? 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, Tadalafil 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.

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-lowering effects, and changes in drug levels through the liver enzyme CYP3A4, where grapefruit raises them and St. John's wort lowers them, both rated major.

Beyond those, 38 ingredients, including alcohol in beer and wine, add strain on the liver, which matters since macitentan's class is watched for liver injury, and activated charcoal can blunt absorption of anything taken by mouth, so space it away from your dose. Of the 264, 215 rate moderate and 39 minor, mostly gentler versions of the same pressure and drug-level themes; the ten majors are where your reading should start.

— , Clinical Pharmacist · July 18, 2026

Major 10 Moderate 215 Minor 39 No known interaction 1,188

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 ↓

Most Viewed Ingredient Interactions

Macitentan, Tadalafil: Top Interactions at a Glance

The Macitentan, Tadalafil supplement & herbal interactions people checked most in the last 24 hours, colored by severity. Tap any ingredient to open the full report for that pair.

Showing the 12 highest-ranked of 264 interacting ingredients — plus 1,188 more checked with no known interaction. See the complete ranked list.

Start here

The Most-Checked Macitentan, Tadalafil Combinations Today

The Macitentan, Tadalafil + supplement pages people viewed most in the last 24 hours (resets at midnight). Open any card for the full report.

Moderate Likelihood Possible Betony + Macitentan, Tadalafili

Theoretically, betony might have additive effects with blood pressure lowering drugs due to hypotensive activity of the glycosides found in betony.

Read the full interaction Moderate Likelihood Possible Bishop's Weed + Macitentan, Tadalafili

Bergapten, a constituent of bishop's weed, has been shown to inhibit cytochrome P450 3A4 (CYP3A4) in vitro.

Read the full interaction Moderate Likelihood Possible Vitamin A + Macitentan, Tadalafili

Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.

Read the full interaction Moderate Likelihood Possible German Chamomile + Macitentan, Tadalafili

Theoretically, German chamomile might inhibit CYP2C9 and increase levels of drugs metabolized by these enzymes.

Read the full interaction Major Likelihood Likely Grapefruit + Macitentan, Tadalafili

Grapefruit juice can increase levels of drugs metabolized by CYP3A4.

Read the full interaction Minor Likelihood Possible Coenzyme Q10 + Macitentan, Tadalafili

Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.

Read the full interaction
The complete list

Every Supplement Checked Against Macitentan, Tadalafil

All 1,452 ingredients in our database, ranked by severity — 264 with a Macitentan, Tadalafil interaction on file and 1,188 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, Tadalafil?

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 Betony with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, betony might have additive effects with blood pressure lowering drugs due to hypotensive activity of the glycosides found in...

Full Betony + Macitentan, Tadalafil answer

Can you take Bishop's Weed with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Bergapten, a constituent of bishop's weed, has been shown to inhibit cytochrome P450 3A4 (CYP3A4) in vitro.

Full Bishop's Weed + Macitentan, Tadalafil answer

Can you take Vitamin A with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disea...

Full Vitamin A + Macitentan, Tadalafil answer

Can you take German Chamomile with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, German chamomile might inhibit CYP2C9 and increase levels of drugs metabolized by these enzymes.

Full German Chamomile + Macitentan, Tadalafil answer

Can you take Grapefruit with Macitentan, Tadalafil?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Grapefruit juice can increase levels of drugs metabolized by CYP3A4.

Full Grapefruit + Macitentan, Tadalafil answer

Can you take Ginger with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Ginger might increase or decrease the levels of CYP3A4 substrates.

Full Ginger + Macitentan, Tadalafil answer

Can you take Ginkgo with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, ginkgo might increase levels of drugs metabolized by CYP2C9.

Full Ginkgo + Macitentan, Tadalafil answer

Can you take Goji with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, concomitant use of goji root bark, but not goji fruit, with antihypertensive drugs might have additive effects.

Full Goji + Macitentan, Tadalafil answer

Can you take Goldenseal with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, goldenseal might increase the risk of hypotension when taken with antihypertensive drugs.

Full Goldenseal + Macitentan, Tadalafil answer

Can you take Goldthread with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. There's very preliminary evidence that berberine, a constituent of goldthread, might inhibit cytochrome P450 3A4 (CYP3A4) enzyme.

Full Goldthread + Macitentan, Tadalafil answer

Can you take Gotu Kola with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.

Full Gotu Kola + Macitentan, Tadalafil answer

Can you take Grape with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. It is unclear if grape seed extract inhibits or induces CYP3A4; research is conflicting.

Full Grape + Macitentan, Tadalafil answer

Can you take Greater Celandine with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. There is some concern that greater celandine can adversely affect the liver.

Full Greater Celandine + Macitentan, Tadalafil answer

Can you take Guar Gum with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Guar gum might reduce the absorption of some oral drugs, potentially decreasing their effectiveness.

Full Guar Gum + Macitentan, Tadalafil answer

Can you take Guarumo with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Evidence from animal research suggests that aqueous and ethanolic extracts of guarumo leaf can lower blood pressure when administered intrav...

Full Guarumo + Macitentan, Tadalafil answer

Can you take Gum Arabic with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, gum arabic can alter the absorption of oral drugs due to its fiber content.

Full Gum Arabic + Macitentan, Tadalafil answer

Can you take Gymnema with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, gymnema might increase or decrease levels of drugs metabolized by CYP2C9.

Full Gymnema + Macitentan, Tadalafil answer

Can you take Hemp Agrimony with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Hemp agrimony contains hepatotoxic pyrrolizidine alkaloids (PA).

Full Hemp Agrimony + Macitentan, Tadalafil answer

Can you take Hesperidin with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, taking hesperidin with antihypertensive drugs might increase the risk of hypotension.

Full Hesperidin + Macitentan, Tadalafil answer

Can you take Hibiscus Sabdariffa with Macitentan, Tadalafil?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, taking Hibiscus sabdariffa with antihypertensive drugs might increase the risk of hypotension.

Full Hibiscus Sabdariffa + Macitentan, Tadalafil 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, Tadalafil is classified into the pharmacology categories it belongs to, (2) every supplement interaction documented against any of those categories is inherited by Macitentan, Tadalafil, 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, Tadalafil sits in 8 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, Tadalafil 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, Tadalafil through this category.

Cytochrome P450 2C9 (Cyp2C9) Substrates 64 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.

64 of the supplement ingredients on this page reach Macitentan, Tadalafil 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, Tadalafil 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, Tadalafil through this category.

Phosphodiesterase-5 Inhibitors 3 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.

3 of the supplement ingredients on this page reach Macitentan, Tadalafil through this category.

Vasodilators 3 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.

3 of the supplement ingredients on this page reach Macitentan, Tadalafil through this category.

Tadalafil (Cialis) 1 ingredient

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.

1 of the supplement ingredient on this page reaches Macitentan, Tadalafil through this category.

Related: does Macitentan, Tadalafil deplete any nutrients?

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

Check a real product

Take a Supplement Product? Check the Whole Bottle Against Macitentan, Tadalafil

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, Tadalafil.

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Pharmacist Counseling Corner

Macitentan, Tadalafil & Supplements: Common Questions

What supplements interact with Macitentan, Tadalafil?
More than you might expect — 264 in total, though they are far from equal: 10 are rated major, 215 moderate, and 39 minor. The ranked list on this page puts the ones that genuinely matter first, and every entry opens a full report on that exact pair. The highest-ranked right now: American Hellebore, Grapefruit, Siberian Cocklebur.
Which Macitentan, Tadalafil supplement interactions are the most serious?
The 10 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, Tadalafil?
Usually yes — most people on Macitentan, Tadalafil can take most supplements. The catch is the exceptions, and they aren't always the exotic ones (St. John's Wort trips up more prescriptions than almost anything sold next to it). Look up each ingredient you actually take in the list above, and treat "no known interaction" as a green-ish light, not a guarantee. Try the label scanner or the interaction checker.
Do brands like Opsynvi have the same supplement interactions as Macitentan, Tadalafil?
Yes — Opsynvi all contain Macitentan, Tadalafil, 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, Tadalafil deplete any vitamins or nutrients?
It might — Macitentan, Tadalafil 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, Tadalafil nutrient depletion report for the specifics and what to discuss with your pharmacist.
What about Macitentan, Tadalafil and my other medications?
This page covers Macitentan, Tadalafil against supplements and herbal ingredients. Checking Macitentan, Tadalafil 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.

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

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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 September 25, 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.