Drug & supplement interaction

Apple Cider Vinegar + Tolbutamide

Tolbutamide brand name: Orinase.

Minor Interaction
Medically reviewed by · Updated September 2026
The bottom line Minor

Apple Cider Vinegar has a minor interaction with Tolbutamide. Theoretically, taking apple cider vinegar with antidiabetes drugs might increase the risk of hypoglycemia.

Read the full interaction report
SeverityMinor
LikelihoodPossible
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Apple Cider Vinegar and Tolbutamide

Here is the interaction we found between these two, with the evidence behind it.

Minor

ANTIDIABETES DRUGS

Why this applies to Tolbutamide

Tolbutamide falls under ANTIDIABETES DRUGS — the group Apple Cider Vinegar interacts with.

Theoretically, taking apple cider vinegar with antidiabetes drugs might increase the risk of hypoglycemia.
Apple cider vinegar might reduce fasting and postprandial blood glucose levels and decrease gastric emptying in people with diabetes. However, not all research agrees. Theoretically, it might have additive effects on glucose levels when used with antidiabetes drugs.
Severity Minor Likelihood Possible Evidence B

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version: tolbutamide (Orinase) already works hard to lower your blood sugar by nudging your pancreas to release more insulin. Apple cider vinegar may give a small extra blood-sugar-lowering push of its own, partly by slowing how fast your stomach empties. Stack the two together and, in theory, your sugar could dip a little lower than expected.

Honestly, the evidence here is thin and the effect is mild, so I wouldn't lose sleep over a splash of vinegar on your salad. But if you're regularly taking concentrated ACV doses, just keep an eye out for low blood sugar signs: shakiness, sweating, hunger, dizziness, or feeling foggy. Don't change anything on your own. A quick chat with your pharmacist or doctor, plus checking your glucose, is the safest move.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. BMC Gastroenterol 2007;7:46. PubMed
  2. Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care 2004;27:281-2. PubMed
  3. Hadi A, Pourmasoumi M, Najafgholizadeh A, Clark CCT, Esmaillzadeh A. The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials. BMC Complement Med Ther 2021;21(1):179. PubMed
  4. Feise NK, Johnston CS. Commercial vinegar tablets do not display the same physiological benefits for managing postprandial glucose concentrations as liquid vinegar. J Nutr Metab 2020;2020:9098739. PubMed
  5. Gheflati A, Bashiri R, Ghadiri-Anari A, Reza JZ, Kord MT, Nadjarzadeh A. The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: A randomized contro

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Apple Cider Vinegar Also Interacts With Other Medications

Apple Cider Vinegar has 89 moderate, 72 minor known drug interactions in our database — the Tolbutamide one above is one of them. If you take anything else, check it against the full list below.

Moderate 89 Minor 72 No known interaction 2,669 (incl. Tolbutamide)
Taking anything else?

Check Another of Your Medications Against Apple Cider Vinegar

Covers the 2,830 medications we’ve checked against Apple Cider Vinegar. Pick one to open its full report.

From our Q&A

Questions About Apple Cider Vinegar or Tolbutamide

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Apple Cider Vinegar or Tolbutamide, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Tolbutamide

This page covers Apple Cider Vinegar only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Tolbutamide page lists 305 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Siberian Cocklebur (major), Acai (moderate), Adrafinil (moderate) and African Wild Potato (moderate).

By severity: 2 major · 255 moderate · 48 minor.

From our pharmacist’s overview on the Tolbutamide page

“People take tolbutamide (Orinase) to lower blood sugar in type 2 diabetes, and diabetes is exactly the condition supplement shelves target, which is why this list runs to 305 ingredients and deserves real caution. Of those, 239 also push glucose around, most often downward, so combining them can drive sugar lower than intended.”

Reviewed by 2 · Jul 18, 2026

Open the Tolbutamide interaction page

One more smart check

Taking Apple Cider Vinegar as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1,329 real supplement products containing Apple Cider Vinegar, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Apple Cider Vinegar. Your product may carry other ingredients that interact with Tolbutamide too, on top of Apple Cider Vinegar — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Apple Cider Vinegar and Tolbutamide Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Apple Cider Vinegar
Top 10%

#119 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Tolbutamide
Steady interest

#1,655 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Apple Cider Vinegar

What is Apple Cider Vinegar?

Apple Cider Vinegar
  • Blood sugar support
  • Weight management
  • Digestive upset
  • Appetite control
  • Skin and hair care

Apple cider vinegar is a fermented apple product that many people use hoping to help with blood sugar, weight, or digestion. The evidence for most of these uses is limited and mixed, and the modest effects seen in small studies are not a substitute for proven treatments. When diluted and used in small amounts it is generally safe for most people, but undiluted vinegar can harm teeth and the throat.

Read the full Apple Cider Vinegar monograph & all interactions
Medication

About Tolbutamide

What Is Tolbutamide Used For?

Brand name: Orinase

  • Tolbutamide is used along with diet and exercise, and sometimes with other medications, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Tolbutamide is in a class of medications called sulfonylureas. Tolbutamide lowers blood sugar by causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the body) and helping the body use insulin efficiently. This medication will only help lower blood sugar in people whose bodies produce insulin naturally. Tolbutamide is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic ketoacidosis (a serious condition that may occur if high blood sugar is not treated).

  • Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.

See full Tolbutamide drug information
Keep checking

Other Drugs & Apple Cider Vinegar

Browse every other medication we’ve checked against Apple Cider Vinegar — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
89Moderate
72Minor
2,668No known interaction
89 Moderate 72 Minor 2,668 No interaction
Moderate

89 interactions

Showing 60 of 89 moderate interactions — see all 89 on the Apple Cider Vinegar page.

Minor

72 interactions

Showing 60 of 72 minor interactions — see all 72 on the Apple Cider Vinegar page.

No interaction 2,668 drugs checked — show the list

We also checked Apple Cider Vinegar against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,668 medications checked with no known interaction — see the full Apple Cider Vinegar list.

See the full Apple Cider Vinegar interactions page
See every supplement checked against Tolbutamide, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Apple Cider Vinegar monograph › Uses, safety, and every drug interaction in one place Tolbutamide supplement interactions › Every supplement checked against Tolbutamide, ranked by severity Tolbutamide drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Apple Cider Vinegar and Tolbutamide Together: Common Questions

Can you take Apple Cider Vinegar with Tolbutamide?
There is only a minor interaction, which is usually not serious. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Apple Cider Vinegar and Tolbutamide interaction?
We rate it Minor. This interaction is generally not clinically significant, but it remains worth noting and discussing with your pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Tolbutamide and Apple Cider Vinegar?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.