Who Should Avoid Taking Nitrate Supplements?

November 28, 2025 •

4 min read

Nitrate supplements, often derived from beetroot, are known to lower blood pressure by promoting vasodilation. However, this effect, while beneficial for some, makes it crucial to understand who should avoid taking nitrate supplements to prevent serious health complications, from dangerously low blood pressure to adverse drug interactions.

Quick Summary

Specific populations, including those with low blood pressure, certain heart conditions, or kidney disease, should avoid nitrate supplements, as should individuals on particular medications like PDE-5 inhibitors.

Key Points

Heart Conditions: Individuals with certain heart conditions, such as a recent heart attack, right ventricular infarction, or hypertrophic cardiomyopathy, should strictly avoid nitrate supplements.
Low Blood Pressure (Hypotension): Due to its blood pressure-lowering effect, nitrate supplements can be dangerous for individuals with hypotension, risking a severe drop in blood pressure.
Drug Interactions: Never take nitrate supplements in combination with phosphodiesterase (PDE-5) inhibitors (like sildenafil) or certain blood pressure and diabetes medications, as this can cause unsafe blood pressure changes.
Pregnancy and Breastfeeding: There is insufficient evidence to confirm the safety of nitrate supplementation during pregnancy and lactation, so it is recommended to avoid them.
Kidney Stone Risk: Beetroot-derived nitrate supplements are high in oxalates, which can increase the risk of kidney stone formation in predisposed individuals.
Allergies: Anyone with a known allergy to nitrates or beet products should avoid supplementation to prevent allergic reactions.
Medical Consultation: Always consult a doctor before starting a nitrate supplement, especially if you have pre-existing conditions or are on other medications.

Contraindications for Nitrate Supplements

Nitrate supplements are not universally safe and should be avoided by several groups of people to prevent potential health risks. These contraindications often relate to the supplement's potent vasodilatory effects.

Heart Conditions

Individuals with pre-existing heart conditions must exercise extreme caution or avoid nitrate supplements entirely. The potent blood pressure-lowering effect can worsen certain cardiac issues.

Recent Heart Attack: A 2006 study found that individuals taking L-arginine, a precursor to nitric oxide, after a heart attack had a higher risk of adverse outcomes, including death.
Right Ventricular Infarction: Patients with this condition are preload sensitive, and nitrates can cause severe hypotension, or dangerously low blood pressure.
Hypertrophic Cardiomyopathy: In this condition, the heart muscle thickens. Decreased left ventricular volume from reduced preload can worsen outflow tract obstruction.

Low Blood Pressure (Hypotension)

Since nitrate supplements effectively lower blood pressure, they can worsen symptoms in those who already have low or normal blood pressure, potentially causing dizziness, lightheadedness, or fainting. Patients with autonomic nervous system dysregulation are also at a higher risk of postural hypotension.

Kidney Conditions

For individuals with compromised kidney function, certain nitrate sources pose additional risks.

Kidney Stones: Beetroot powder, a common nitrate supplement, is high in oxalates, which can contribute to kidney stone formation in susceptible individuals.
Pre-existing Kidney Disease: While some studies show potential benefits in chronic kidney disease (CKD) patients, general medical opinion advises caution, and supplementation should only occur under strict medical supervision.

Allergy to Nitrates

Any individual with a known allergy to nitrates or any of the ingredients in a nitrate supplement should avoid them. Allergic reactions can include skin rash, itching, swelling, or difficulty breathing.

Drug Interactions to Know

One of the most critical reasons to avoid nitrate supplements is their potential to interact dangerously with other medications, particularly those that also affect blood pressure.

Phosphodiesterase-5 (PDE-5) Inhibitors

Combining nitrate supplements with PDE-5 inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra), is absolutely contraindicated. Both substances cause vasodilation, and their combined effect can lead to a severe and potentially life-threatening drop in blood pressure.

Blood Pressure Medications

Nitrate supplements can enhance the blood pressure-lowering effects of antihypertensive drugs, including ACE inhibitors (like lisinopril), beta-blockers, and calcium channel blockers. This can lead to blood pressure dropping too low, resulting in dizziness or fainting. Patients on chronic diuretic therapy may also be volume-depleted and at increased risk of hypotension.

Diabetes Medications

Certain supplements, like L-arginine, may lower blood sugar levels. Combining these with diabetes medications, such as insulin, can amplify their effects and cause hypoglycemia (low blood sugar), leading to symptoms like tremors and sweating.

Special Populations: Pregnancy, Lactation, and Children

Pregnant and Breastfeeding Women

Research on the safety of nitrate supplementation during pregnancy and breastfeeding is limited. For this reason, it is generally recommended to avoid these supplements as a precaution. Excessive nitrate intake can lead to maternal and fetal complications, including methemoglobinemia. While beetroot intake in moderation may be safe, the high concentration in supplements is not adequately studied.

Children

There is also limited information on the effects and safety of nitrate supplements in children. Therefore, children should not take these supplements without explicit medical guidance.

The Importance of Medical Consultation

Before taking any supplement, including those containing nitrates, a consultation with a healthcare provider is essential. This is particularly true if you have a pre-existing health condition, are taking prescription medication, or belong to a vulnerable population. A doctor can assess the potential risks and benefits for your specific situation and recommend a course of action.

Nitrate Supplementation Risks vs. Benefits: A Comparison


Population/Condition	Risk Factor	Reason for Avoidance/Caution
Low Blood Pressure (Hypotension)	Excessive blood pressure drop	Vasodilatory effect can lead to dangerously low blood pressure, dizziness, and fainting.
Recent Heart Attack	Increased adverse events	In a 2006 study, L-arginine supplementation was linked to increased risk of repeat heart attack and death.
Right Ventricular Infarction	Severe hypotension	Preload sensitivity can be exacerbated by nitrate-induced vasodilation.
Taking PDE-5 Inhibitors	Life-threatening hypotension	Synergistic vasodilatory effect can cause a severe and dangerous drop in blood pressure.
Kidney Stones (Prone)	Increased stone formation	Beetroot powder's high oxalate content can contribute to kidney stone development.
Pregnancy / Breastfeeding	Insufficient safety data	Potential for methemoglobinemia and other risks; safety has not been fully evaluated.

Conclusion: Prioritizing Your Health

While nitrate supplements are increasingly popular for their potential benefits in athletic performance and cardiovascular health, they are not a one-size-fits-all solution. For certain individuals with conditions like low blood pressure, specific heart issues, or a history of kidney stones, the risks can far outweigh the benefits. The potential for dangerous interactions with medications for erectile dysfunction, blood pressure, and diabetes further underscores the need for caution. Always consult a qualified healthcare professional before starting any new supplement regimen. Your health and safety should be the top priority, and a medical expert can provide personalized guidance based on your medical history and current health status. National Institutes of Health (NIH)

Frequently Asked Questions

Individuals with a history of a recent heart attack, those with right ventricular infarction, or hypertrophic cardiomyopathy should avoid nitrate supplements. This is due to the risk of severe hypotension and other cardiac complications.

No, individuals with low blood pressure (hypotension) or those prone to it should avoid nitrate supplements. The supplement's vasodilatory effect can further lower blood pressure, causing dizziness, fainting, and other risks.

Combining nitrate supplements with phosphodiesterase-5 (PDE-5) inhibitors for erectile dysfunction (e.g., sildenafil, tadalafil) is extremely dangerous and can cause a life-threatening drop in blood pressure. Interactions also exist with some blood pressure and diabetes medications.

Safety data is limited for pregnant and breastfeeding women, and potential risks like methemoglobinemia exist. Therefore, it is generally recommended to avoid nitrate supplements unless a doctor advises otherwise.

If you are prone to kidney stones, you should avoid beetroot powder, as it is high in oxalates. Oxalates can contribute to the formation of kidney stones in susceptible individuals.

Common side effects include headaches, dizziness, nausea, bloating, and gastrointestinal upset. In rare cases, more severe effects like methemoglobinemia or allergic reactions can occur.

Individuals with chronic kidney disease (CKD) should consult a doctor before taking nitrate supplements. While some studies suggest potential benefits for exercise capacity, the safety and impact depend heavily on individual circumstances and require medical supervision.