Rheumatoid Arthritis Medication: Drinks to Avoid
Rheumatic ConditionsRheumatoid Arthritis

4 Drinks That May Not Mix With Your Rheumatoid Arthritis Meds

4 Drinks That May Not Mix With Your Rheumatoid Arthritis Meds
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Updated on December 24, 2023
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What you eat and drink can affect how well your rheumatoid arthritis (RA) medications are absorbed and how well they work. Several common beverages can have a significant impact on the efficacy of pharmaceuticals.

“Rheumatoid arthritis patients have to deal with taking the same medications for the majority of their lifetimes, and they need to be at their appropriate strength when they are in their body,” says Mohamed Jalloh, PharmD, health equity officer at Partnership Healthplan of California in Fairfield, California.

In general, some drinks can make a drug more or less effective, or can increase the risk of side effects.

 When it comes to RA specifically, here are four beverages you should know more about.

1. Alcohol

Alcohol and prescription medications both put the liver to work, so mixing the two may increase the risk of organ damage. While moderate consumption of alcohol may be okay for some people with rheumatoid arthritis — that’s one drink a day for women and two for men, according to the Centers for Disease Control and Prevention (CDC) — the downsides of drinking beer, wine, and spirits may quickly outweigh the benefits.

Methotrexate guidelines from the American College of Rheumatology clearly state that people should avoid alcohol while on this medication, since it significantly increases the risk of liver damage.

 If you have questions, talk to your doctor about rare or occasional alcohol use.

2. Grapefruit Juice

This breakfast table staple is one of the beverages that’s a big drug-interaction culprit, says Dr. Jalloh. “Grapefruit juice blocks the protein known as CYP3A4 that helps the body process medications.”

This is not the case with every type of prescription drug, but it does have an impact on oral Sandimmune (cyclosporine), an immunosuppressant taken by people with RA who have not responded well to other medications.

Research established decades ago that regular consumption of grapefruit juice affects the body’s ability to metabolize the drug, meaning that the levels of the drug increase, which can lead to more side effects.

 “In a sense, you are getting extra drug levels that can get dangerously high in people,” says Jalloh. If you take cyclosporine, talk to your doctor if you want to drink grapefruit juice on a regular basis.
Grapefruit juice isn’t the only type of juice to be cautious about if you’re taking RA medications. Some research has suggested that other citrus juices, like those made from Seville oranges, limes, and pomelos, may also affect how CYP3A4 works in the body.

 Additionally, orange juices have been known to inhibit molecules called organic anion-transporting polypeptides (OATPs), which aid in drug absorption.

While studies have shown mixed results on just how much these juices interact with RA drugs, it’s a good idea to talk to your doctor about your citrus juice consumption if you take prescription medicines.

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3. Willow Bark Tea

An herbal pain relief remedy used for centuries, willow bark is chemically similar to aspirin in that it contains salicin, a compound found to have anti-inflammatory effects. Some studies support the use of willow bark in back pain and osteoarthritis.

 But it can interact negatively with certain medications. If you take nonsteroidal anti-inflammatory medications (NSAIDs), do not consume willow bark as it could increase the risk of stomach and intestinal damage and bleeding. Willow bark should also not be taken if you’re on a blood-thinning medication, as it can increase the risk of bleeding.

Drinks like green tea and ginger tea are popular for easing pain and other rheumatoid arthritis symptoms and are likely better options.

4. Cow’s Milk or Dairy Drinks

You may have heard milk can strengthen your bones, but you should also be aware that dairy products and other calcium-fortified beverages can affect how some drugs are absorbed in the body and make them less effective.

Specifically, the Arthritis Foundation notes that calcium is known to interfere with certain antibiotics and bisphosphonates, which are used to treat osteoporosis, which can be a complication of RA.

 Milk and milk products may decrease the absorption of oral bisphosphonates.

Since milk can interfere with the absorption of several drugs, talk to your doctor or pharmacist about the amount of milk that’s safe to drink with your prescriptions, as well as the best time to consume milk — with your medications or at a different time of day.

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Sian Yik Lim, MD

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Sian Yik Lim, MD, is a board-certified rheumatologist at Hawaii Pacific Health. He is a clinical certified densitometrist, certified by the International Society of Clinical Densit...
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Resources
  1. Food-Drug Interactions. Johns Hopkins Medicine.
  2. About Moderate Alcohol Use. Centers for Disease Control and Prevention. January 14, 2025.
  3. Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo). American College of Rheumatology. February 2025.
  4. Cyclosporine. MedlinePlus. November 15, 2023.
  5. Cyclosporine (Neoral, Sandimmune, Gengraf). American College of Rheumatology. June 2026.
  6. Hollander AAMJ et al. The Effect of Grapefruit Juice on Cyclosporine and Prednisone Metabolism in Transplant Patients. Clinical Pharmacology & Therapeutics. March 1995.
  7. Management of Grapefruit-Drug Interactions. American Family Physician. August 15, 2006.
  8. Chen M et al. Food-Drug Interactions Precipitated by Fruit Juices Other Than Grapefruit Juice: An Update Review. Journal of Food and Drug Analysis. April 2018.
  9. Willow Bark. Memorial Sloan Kettering Cancer Center. December 17, 2021.
  10. Food and Drug Interactions. Arthritis Foundation.
  11. Bisphosphonate. StatPearls. July 3, 2023.