What happens when you take beetroot with tadalafil?
Beetroot and tadalafil both act on the same blood-vessel pathway, from opposite ends. Here is the sequence:
- Beetroot delivers dietary nitrate. Beets are rich in inorganic nitrate. Bacteria in your mouth and gut reduce that nitrate to nitrite, and then to nitric oxide in the body.
- Nitric oxide relaxes your arteries. Nitric oxide signals the smooth muscle lining your blood vessels to relax, which widens the vessels and modestly lowers blood pressure. A concentrated beetroot juice shot has been shown to lower blood pressure by a small but measurable amount for several hours.
- Tadalafil prolongs that same signal. Tadalafil (Cialis, Adcirca) is a long-acting PDE5 inhibitor. It blocks the enzyme that normally breaks down cyclic GMP, the messenger nitric oxide uses to relax vessels. With tadalafil on board, any nitric-oxide effect lingers longer than usual.
- The two effects can stack. Combining concentrated beetroot products with tadalafil raises nitric-oxide production at the same time the drug stretches out its effect. The result can be a slightly deeper or longer blood-pressure dip than tadalafil alone would produce.
This is an additive, mostly mild effect. There are no documented cases of serious low blood pressure caused specifically by beetroot plus tadalafil.
Why is this important?
It helps to separate two different things. Tadalafil carries a formal contraindication against organic nitrate medications such as nitroglycerin and isosorbide. Because tadalafil is long-acting, guidance from groups like the American Heart Association advises keeping those rescue nitrates well separated in time from a tadalafil dose, as the combination can cause severe drops in blood pressure.
Dietary nitrate from food is handled differently from nitrate drugs and is not part of that formal contraindication. The concern with beetroot is gentler: clinical studies show concentrated beetroot juice lowers blood pressure to a meaningful degree, so layering it on top of tadalafil — which is already producing some baseline vasodilation, especially in people taking it daily for an enlarged prostate or pulmonary hypertension — can occasionally tip someone into lightheadedness.
Older adults, people on diuretics or other blood-pressure medicines, people with autonomic neuropathy, and anyone with already-low resting blood pressure are the most likely to notice symptoms.
What should you do?
Whole beets in normal food portions — roasted beets, a few pickled slices, or beets in a smoothie — are generally not a meaningful concern with tadalafil. The caution applies to concentrated products. Here is a simple schedule:
Before you change anything: Tell your doctor or pharmacist about any concentrated beetroot juice shots, beetroot powders, or nitrate-based pre-workout supplements you use or want to add. This matters most if you take tadalafil daily for pulmonary hypertension or an enlarged prostate, or if you already feel lightheaded on standing. Ask them what is reasonable for your blood pressure and other medicines.
Every day: Enjoy whole beets in food amounts freely. If you use a concentrated beetroot product, keep it separated from your tadalafil dosing rather than taking both close together, since the blood-pressure effects can stack. If you have a home blood-pressure monitor, use it when starting any new regimen.
After a change: Watch for dizziness, lightheadedness on standing, a severe headache, or palpitations. If those appear, sit or lie down, hydrate, and reassess your routine with your prescriber. Chest pain or fainting needs prompt medical evaluation.
Which specific products are affected?
This interaction is most relevant to long-acting PDE5 inhibitors, and tadalafil's effect is the most prolonged. On the medication side, that means Cialis (erectile dysfunction and enlarged prostate), Adcirca (pulmonary arterial hypertension), and generic tadalafil.
On the beetroot side, the products that matter are the concentrated ones: beetroot juice shots (Beet It, Love Beets, James White and similar), beetroot crystal or powder supplements marketed for nitric oxide or blood pressure, and pre-workout formulas built around beetroot extract or added nitrate, which often combine it with other vasodilators like citrulline. Whole beets eaten as food are not the focus.
The science behind it
The two component effects are each well documented in humans, even though the specific pairing has not been studied directly.
A randomized, double-blind, placebo-controlled crossover study found that a single concentrated beetroot juice shot lowered systolic blood pressure by a small but measurable amount within about half an hour (PMC6369216) — confirming that concentrated beetroot has a real, if modest, blood-pressure-lowering effect.
On the drug side, a randomized placebo-controlled crossover study by Kloner and colleagues mapped the time course of the tadalafil–nitrate interaction and found it became undetectable once enough time had passed since the dose — the basis for the standard timing-separation advice with nitrates. This shows the mechanism is real and that timing, not total avoidance, is the practical lever for the dietary version of the concern.
Clinical pharmacy guidance rates beetroot extract with PDE5 inhibitors such as tadalafil as a moderate, additive nitric-oxide/blood-pressure interaction — use cautiously and consult a doctor — rather than a serious one. That matches the overall picture: a plausible additive effect, no reports of serious harm.
Frequently Asked Questions
Can I eat beets if I take tadalafil?
Yes. Whole beets in normal food portions deliver modest amounts of nitrate that the body handles routinely, and they are generally not a concern with tadalafil.
What about beetroot juice shots or powders?
These are concentrated and designed to produce a measurable blood-pressure effect. They are the main thing to be thoughtful about. Keep them separated from your tadalafil dosing and mention them to your pharmacist.
Is this as dangerous as taking nitroglycerin with tadalafil?
No. Nitrate medications like nitroglycerin carry a formal contraindication with tadalafil because of the risk of severe blood-pressure drops. Dietary nitrate from beetroot is a milder, additive concern and is not part of that contraindication.
Why does tadalafil matter more than other ED pills here?
Tadalafil is the longest-acting of the PDE5 inhibitors, so its blood-vessel effect lingers well into the next day. That widens the window during which a concentrated beetroot product could add to its effect.
What symptoms should make me stop and pay attention?
Dizziness, lightheadedness on standing, a severe headache, or palpitations are signals to sit down, hydrate, and reassess. Chest pain or fainting needs prompt medical attention.
I take tadalafil daily for pulmonary hypertension — is beetroot off-limits?
Not necessarily, but talk to your prescriber first. Daily tadalafil already produces some baseline vasodilation, so adding a concentrated daily beetroot regimen is worth reviewing before you start.
Key takeaways
- Beetroot and tadalafil both lower blood pressure through the nitric-oxide pathway, so their effects can add up.
- This is a moderate, additive interaction — not the serious contraindication that applies to nitrate medications like nitroglycerin.
- Whole beets in food amounts are generally fine; the caution is for concentrated juice shots, powders, and nitrate pre-workouts.
- Because tadalafil is long-acting, keep concentrated beetroot products separated from your tadalafil dosing rather than taking them together.
- Review any regular beetroot use with your doctor or pharmacist, especially if you take tadalafil for pulmonary hypertension or feel lightheaded on standing.