What happens when you take beetroot with nitroglycerin?
Nitroglycerin and beetroot both raise nitric oxide and relax blood vessels, but they get there by different routes. Stacking concentrated beetroot products on top of nitroglycerin pushes on the same biological lever from two sides. Here is the sequence:
- Nitroglycerin releases nitric oxide. Nitroglycerin is an organic nitrate that the body rapidly converts to nitric oxide in the walls of blood vessels.
- Nitric oxide relaxes blood vessels. It tells the smooth muscle lining veins and arteries to relax, which widens them, lowers blood pressure, and reduces the heart's workload. That is why nitroglycerin relieves chest pain so quickly.
- Beetroot adds dietary nitrate. Beetroot is one of the most concentrated dietary sources of inorganic nitrate. Bacteria on the tongue reduce nitrate to nitrite, and tissues throughout the body convert it further to nitric oxide.
- The effects can overlap. If concentrated beetroot is still active in your system when you take nitroglycerin, both sources are raising nitric oxide at once. The blood pressure dip and the lightheadedness can be a little deeper or more noticeable than with nitroglycerin alone.
It is worth being honest about the size of this effect. Concentrated beetroot juice produces a modest blood pressure drop that peaks within roughly half an hour and is relatively short-lived; it is not a large or long-lasting fall. And no clinical reports of people running into trouble specifically from combining beetroot with nitroglycerin have been published. The concern here is mechanistic and additive, not a documented emergency.
Why is this important?
Nitroglycerin's familiar side effects already include headache, flushing, dizziness, and a drop in blood pressure when you stand up. A concentrated dietary nitrate source nudges in the same direction, so it is reasonable to be aware of the overlap.
The Drugs.com interaction monograph for nitroglycerin flags additive blood-pressure lowering when it is combined with substances that donate nitric oxide. Importantly, that same monograph describes the clinical significance of this combination as unknown rather than established. Concentrated beetroot products fit the nitric-oxide-donor profile, but they are a food-derived source with a milder, briefer effect than a nitrate drug.
Where ordinary whole beets in a meal are not pharmacologically meaningful for most people, beetroot shots, powders, and pre-workout supplements are concentrated enough to have lowered blood pressure on their own in clinical studies. The people most likely to notice anything are those with heart failure, autonomic neuropathy, dehydration, naturally low blood pressure, or who also take other vasodilators such as PDE5 inhibitors, calcium channel blockers, alpha blockers, or diuretics. In those situations, symptomatic low blood pressure can lead to dizziness or, less commonly, fainting.
What should you do?
You do not need to give up beets. The practical goal is simply to avoid layering concentrated, pharmacologic nitrate sources on top of your nitroglycerin. Here is a simple way to manage it.
Before you change anything: If you currently use a beetroot supplement, beetroot juice shot, or a nitrate-based pre-workout product and you take nitroglycerin, bring the bottle to your doctor or pharmacist. They can weigh the benefit against the additive blood-pressure effect and tell you whether to continue, adjust, or stop it. Do not make changes to your nitroglycerin on your own.
Every day: Enjoy beets as food freely — a roasted beet salad, beets in a smoothie, or pickled beets on a sandwich deliver only a small fraction of the amount used in research and are not the concern. Be cautious, however, with concentrated beetroot juice shots, beetroot powder or crystal capsules and scoops marketed for blood pressure or nitric oxide support, and pre-workout supplements built around beetroot extract or sodium nitrate while you are on a nitroglycerin regimen.
After taking nitroglycerin: If you feel sudden severe lightheadedness, a pounding headache, fainting, or unusual heart racing, sit or lie down with your legs elevated and call for medical help. Do not redose nitroglycerin if your blood pressure feels like it is dropping.
Which specific products are affected?
This applies to all forms of nitroglycerin, including sublingual tablets and spray (Nitrostat, Nitrolingual, NitroMist), transdermal patches (Nitro-Dur, Minitran), ointment (Nitro-Bid), and intravenous nitroglycerin. The same logic extends to other organic nitrates such as isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil).
On the dietary side, the products worth caution are concentrated beetroot juice shots, beetroot powder capsules and scoops, and pre-workout nitric oxide boosters built around beetroot or sodium nitrate. Whole-food beets in normal portions are not the issue.
The science behind it
The mechanism rests on real, well-described pharmacology, while the clinical risk of this specific pairing remains uncertain.
- A randomized crossover study in humans by Kukadia and colleagues tracked the blood pressure response to beetroot juice over a full day and found a measurable but modest reduction that peaked early and was relatively short-lived. (PMC6369216)
- A review by Lidder and Webb in the British Journal of Clinical Pharmacology describes the nitrate–nitrite–nitric oxide pathway through which dietary nitrate from foods like beetroot produces vasodilation and lowers blood pressure — the same endpoint nitroglycerin reaches by a different route. (Br J Clin Pharmacol 2013;75:677-696)
- The Drugs.com interaction monograph for nitroglycerin notes that combining it with nitric-oxide donors can have additive effects on blood pressure (and a theoretical methemoglobin concern), but explicitly rates the clinical significance as unknown. (drugs.com interaction monograph)
Taken together: the additive mechanism is real, but the effect of beetroot is mild and brief, and there are no published cases of harm from this combination. That is why this is a moderate, awareness-level caution rather than a hard contraindication.
Frequently Asked Questions
Can I eat beets if I take nitroglycerin?
Yes. Whole beets in ordinary food amounts — roasted, pickled, or in a smoothie — deliver only a small fraction of the nitrate used in research and are not a meaningful concern.
What about concentrated beetroot juice shots or powders?
These are concentrated enough to lower blood pressure on their own. It is reasonable to be cautious with them while on nitroglycerin and to review them with your doctor or pharmacist rather than starting them on your own.
Is this combination dangerous?
There are no published cases of harm from combining beetroot with nitroglycerin. The concern is a plausible additive blood-pressure effect, which is why this is treated as a moderate, awareness-level caution rather than something forbidden.
Who is most at risk?
People with heart failure, autonomic neuropathy, dehydration, naturally low blood pressure, or who also take other vasodilators (PDE5 inhibitors, calcium channel blockers, alpha blockers, diuretics) are the most likely to notice symptoms.
What symptoms should make me stop and seek help?
Sudden severe lightheadedness, a pounding headache, fainting, or unusual heart racing after a nitroglycerin dose. Sit or lie down with your legs elevated and call for medical help; do not redose nitroglycerin.
Does this apply to other nitrate medications?
Yes. The same reasoning applies to other organic nitrates such as isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil).
Key takeaways
- Nitroglycerin and beetroot both raise nitric oxide and can lower blood pressure, through different routes.
- Whole-food beet portions are not a meaningful concern.
- Concentrated beetroot juice shots, powders, and nitrate-based pre-workout supplements act like a mild nitrate source and could add to nitroglycerin's blood-pressure drop and dizziness.
- The interaction is mechanistic and modest; no clinical cases of this specific pairing have been documented, and the effect of beetroot is mild and short-lived.
- If you use a concentrated beetroot or nitrate supplement, review it with your doctor or pharmacist so they can monitor for symptomatic low blood pressure.