Cialis With Beet Root Supplement Interaction Concerns

Answer

Thanks for your question! It’s a great one to explore, especially since beet supplements are commonly used to boost nitric oxide levels, and medications like Cialis (as well as all PDE5 inhibitors) carry warnings about combining them with nitrates.

Before getting into the details, I can tell you that it is generally safe to take a beet root powder supplement within the same 24-day period as Cialis (tadalafil), assuming both are being used appropriately and under normal dosing conditions. I explore this more in the sections below.

Why There’s No Known Interaction

Beet root powder is commonly used as a nutritional supplement for its natural nitrate content, which your body converts into nitric oxide (NO). This nitric oxide has mild vasodilating effects, meaning it can help relax blood vessels and improve circulation.

Cialis (tadalafil), a PDE5 inhibitor, also works by enhancing nitric oxide signaling, but through a different mechanism: it prevents the breakdown of cyclic GMP, which nitric oxide helps stimulate.

After the breakdown of cyclic GMP is prevented, levels of cyclic GMP remain elevated in the smooth muscle cells lining blood vessels. This sustained elevation causes the muscles to stay relaxed longer, allowing blood vessels to remain dilated. In the case of Cialis, this primarily improves blood flow to specific areas like the penis, aiding in the treatment of erectile dysfunction.

The major safety concern with PDE5 inhibitors is when they’re taken alongside nitrate medications (like nitroglycerin), which can cause a sharp and unsafe drop in blood pressure due to the excessive vasodilation that can occur.

While both beets and Cialis affect blood vessel tone through nitric oxide pathways, the level of nitric oxide generated by beet root supplements is only modest and generally not clinically significant enough to cause a dangerous interaction with Cialis.

What the Research Shows

• Beet root has been safely used in clinical trials in doses of up to 500 mL daily for up to 7 days as juice, or 100 grams daily, without adversely affecting health.
• Peak nitrite levels (the active nitric oxide precursor) occur around 2–4 hours after ingestion, and nitrate levels can remain elevated for up to 24 hours.
• A standard 70 mL serving of beetroot juice provides around 6.5–7.0 mmol of nitrate, far less potent than the nitrate doses found in cardiac medications.
• Increased nitric oxide levels have been documented in plasma and breath samples, but without significant changes to systolic or diastolic blood pressure in healthy individuals.

All of this is to day that while beet root supplementation may support vascular health and athletic performance through an increase nitric oxide production, its effect is mild and gradual, and it does not create a risk comparable to that seen with prescription nitrates.

Are There Any Risks?

In healthy adults, beet root supplements are generally well tolerated. The most common side effects include:

• Red or pink urine/stool (a harmless effect known as beeturia)
• Mild gastrointestinal upset in some cases

In rare cases, extremely high doses of beet have been associated with hypocalcemia or kidney strain, so be sure to stick to standard serving sizes is advised.

There is also some in vitro evidence that beet may mildly affect the metabolism of drugs processed by CYP1A2 or CYP3A4 enzymes, though this has not been confirmed in humans at supplement doses.

The Bottom Line

To reiterate, it is generally thought you can safely take beet root powder within the same 24-day period as Cialis.  As I've discussed in this answer, the nitric oxide boost from beet root is modest, and there’s no evidence of a harmful interaction.

As always, I recommend speaking to your doctor first before changing your medication regimen so you can be appropriately monitored.