Methotrexate and Beet Root: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Methotrexate
Beet Root
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Methotrexate toxicity
Interaction Deep Dive
In a case report, consumption of beet root juice 200 mL/day and methotrexate 17.5 mg/week resulted in methotrexate intoxication due to altered methotrexate transport in a patient with psoriasis1. Avoid concomitant use.
Why it happens (mechanism)
Altered methotrexate transport by beet root
Literature reports
1 report — tap to read
a) A 50-year-old woman with a 15-year history of psoriasis experienced methotrexate intoxication following consumption of beetroot juice 200 mL/day and methotrexate 17.5 mg/week for 2 weeks for worsening psoriasis. She was previously receiving methotrexate 15 mg/week for 1 year. The patient presented with hemorrhagic painful ulcerations of the oral cavity, inguinal, and genital areas. Laboratory assessment revealed leucopenia (3.2 x 10(3)/mcL), thrombocytopenia (22 x 10(3)/mL), hematuria, increased erythrocyte sedimentation rate (38 mm/hr), increased C-reactive protein (74 mg/L), and folic acid deficiency. Upon physical examination there were malodorous, purulent, and macerated superficial ulcerations with hemorrhagic crusts in the inguinal and genital regions, and covering the old psoriatic plaques involving her palms, elbows, and knees. Following initiation of cefazolin and folic acid, her platelet and white blood cells counts normalized within a week, and the ulcerations healed completely 1.
Common questions
Can I take Methotrexate and Beet Root together?
Methotrexate toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Methotrexate and Beet Root interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Methotrexate or Beet Root need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Gonul M, Keseroglu H, & Hacinecipoglu F: A case of methotrexate intoxication in a patient with psoriasis who drank beetroot juice during methotrexate treatment. Clin Exp Dermatol 2016; 41(8):893-895. DOI
Keep reading about Methotrexate
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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