Prescription Preworkout: Tadalafil and L-Citrulline for Vascular Performance, Increased Strength and Muscle Pump
Traditional preworkout supplements often rely on stimulants like caffeine or yohimbine to deliver short-term energy and vascular effects. While these ingredients may enhance alertness and temporary vasodilation, they often come with side effects like anxiety, rapid heart rate, and crashes. At the Performance Medicine Institute, we offer a prescription alternative grounded in vascular physiology: a combination of daily tadalafil (5mg) and L-citrulline (750-1500mg) to safely and sustainably enhance performance, blood flow, and muscle pump without overstimulation.
How This Formula Works
This approach supports nitric oxide signaling, which plays a central role in vascular dilation, nutrient delivery, and muscle performance.
Tadalafil (5mg daily)
- A long-acting PDE5 inhibitor, tadalafil blocks the breakdown of cyclic guanosine monophosphate (cGMP), a key messenger in nitric oxide–mediated vasodilation
- Increases arterial inflow and capillary perfusion to muscles during exercise
- Improves endothelial function and enhances vascular responsiveness over time
- Has additional benefits in reducing delayed onset muscle soreness (DOMS), improving oxygen delivery, and supporting recovery
- Long half-life so it is not necessary to take right before your workout
- Daily dosing avoids peak-and-crash effects seen in stimulants
L-Citrulline (750-1500mg)
- A non-essential amino acid that serves as a precursor to L-arginine, which is then converted into nitric oxide (NO)
- Unlike L-arginine, L-citrulline is not degraded in the gut and has better bioavailability for NO production
- Enhances muscle pump, vascular elasticity, and endurance capacity
- Supports ammonia clearance, reducing fatigue during high-intensity workouts
Together, tadalafil and L-citrulline synergistically promote sustained nitric oxide signaling, resulting in better blood flow, vascular pump, and muscle oxygenation without overstimulation or cardiovascular strain.
Why This Preworkout Outperforms Traditional Formulas
| Feature | Traditional Preworkout | Tadalafil + L-Citrulline |
| Energy Source | Stimulants (caffeine, yohimbine) | Cellular vasodilations, NO pathways |
| Duration | Short acting (1-3 hours) | Long acting (up to 36 hours) |
| Side Effects | Jitters, crashes, GI upset, elevated BP | Minimal, well tolerated at daily doses |
| Physiologic Target | CNS stimulation | Vascular and endothelial support |
| Muscle Pump | Transient | Sustained, perfusion-based |
| Recovery Benefit | None or minimal | Enhanced nutrient delivery and metabolic recovery |
| Additional Benefits | None or minimal | Improved erectile function, reduced blood pressure, increased muscle protein synthesis |
Who Can Benefit From This Combination Preworkout
This formula is particularly beneficial for:
- Resistance training athletes looking for enhanced pump and vascularity
- Endurance athletes seeking better muscle oxygenation without HR elevation
- Individuals with stimulant sensitivity or cardiovascular contraindications
Additional Benefits
Long term use of tadalafil has been associated with reduced rates of cardiovascular disease, high blood pressure, strokes, prostate cancer, and benign prostatic hyperplasia.
Potential Risks
While generally safe, tadalafil + L-citrulline should generally be carefully used or not be taken by individuals with:
- Low blood pressure (less than 90/60 mmHg)
- Recent cardiovascular events (heart attacks, strokes)
- Severe liver or kidney impairment
- Retinal disorders
- Using alpha-blockers
- Bleeding disorders
Clinical Safety and Use
Our prescription preworkout can be taken once daily, regardless of workout timing. It may be used safely alongside other supplements and can be combined with creatine, beta-alanine, or electrolyte support for a broader performance stack.
Tadalafil 5mg is FDA approved for daily use and is well tolerated in healthy individuals. We screen for contraindications (such as nitrate therapy or severe hypotension) before prescribing. L-citrulline, even at doses up to 3 grams per day, is considered safe and has been shown to improve vascular reactivity and exercise efficiency.
We can prescribe tadalafil to medically appropriate patients, and we recommend L-citrulline from Nutricost.3
Conclusion
Our prescription preworkout represents a shift from stimulant-based, short-lived energy boosters to vascularly active, physiology-enhancing performance support. With benefits for both strength and endurance athletes, tadalafil and L-citrulline work together to increase nitric oxide, support muscle function, and improve post-exercise recovery. Interested in trying a prescription-based approach to your workouts? Contact Us
References
Bailey, S. J., et al. (2009). L-Citrulline supplementation improves oxygen uptake kinetics and high-intensity exercise performance. Journal of Applied Physiology, 107(4), 1161–1167.
Kloner, R. A., et al. (2004). Cardiovascular effects of tadalafil. The American Journal of Cardiology, 93(9), 1431–1435.
Cormio, L., et al. (2011). Daily tadalafil improves endothelial function in men with increased cardiovascular risk. The Journal of Sexual Medicine, 8(1), 111–121.
Hickner, R. C., et al. (2006). L-Citrulline reduces time to exhaustion and improves exercise performance. British Journal of Sports Medicine, 40(7), 537–541.