Is Apple Cider Vinegar Safe If You Take Methotrexate?

The pharmacist explores ACV safety with methotrexate in our latest question and answer.

Question

Is it safe for me to take cider vinegar while taking methotrexate?

Asked by Whizz On Jul 22, 2023

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Aug 08, 2023
Last updated May 20, 2024

Key points

  • Interactions between apple cider vinegar and methotrexate have not been reported but some studies suggest acidic urine may affect methotrexate levels.

Quick Answer

There are no reported interactions between apple cider vinegar (ACV) and methotrexate (MTX). However, it's important to note that some studies have suggested a potential link between acidic urine caused by certain foods or drinks, like cola, and elevated methotrexate concentrations.

An isolated case report (linked in the next section below) indicated that repeated consumption of cola beverages led to delayed methotrexate elimination and acute renal failure in one individual. While this serves as a cautionary example, further research is needed to establish definitive connections.

Detailed Answer

Apple cider vinegar (ACV) is a popular natural remedy, and methotrexate (MTX) is a medication often used to treat various conditions.

As mentioned in the 'quick answer' section, there are currently no documented interactions between ACV and MTX. This lack of reported interactions suggests that ACV is unlikely to directly affect the absorption, efficacy, or metabolism of methotrexate in most cases.

However, it's essential to consider the broader context and some findings from studies related to acidic substances and methotrexate.

Certain studies have indicated that substances that acidify the urine, such as cola drinks, might have an impact on methotrexate concentrations in the body. Vinegar would likely fit into this category as well as it is acidic.

One isolated case report, in particular, sheds light on the potential effects of acidic beverages. In this case report, an individual experienced delayed elimination of methotrexate and acute renal failure after consuming cola beverages. The acidic nature of cola, attributed to its phosphoric acid content, led to unexpected urinary acidity and subsequently impacted methotrexate elimination.

The individual's recovery was achieved through discontinuation of cola drinks, increased administration of calcium folinate rescue and sodium bicarbonate, which supported methotrexate elimination and renal recovery.

It's important to highlight that this case report is an isolated instance and doesn't provide conclusive evidence of a widespread issue. More extensive research involving larger populations is necessary to establish a clear connection between acidic substances and methotrexate interactions.

As a precaution, especially if you're on high-dose methotrexate treatment, it might be advisable to consider abstaining from acidic beverages, including cola, within the 24-hour period before and during methotrexate administration. This precaution could help mitigate any potential impact on methotrexate elimination and ensure your safety during treatment. However, always consult with your healthcare provider before making any adjustments to your medication or dietary habits.

Final Words

I hope this answer was helpful and please be sure to reach back out anytime!

References

  • Methotrexate Prescribing Information, AccessFDA
  • Cola beverage and delayed elimination of methotrexate, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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