6 Drinks That Don’t Mix With Rheumatoid Arthritis Meds

Some beverages, including grapefruit juice, may have a significant impact on RA medication.

grapefruit juice
Some of the most refreshing, flavorful beverages make the worst RA medication chasers.Javier Zayas/Getty Images

You probably already pay close attention to the foods you eat — and when you eat them — in order for your RA medications to be absorbed properly and work most effectively. But you may be overlooking an important thing you’re consuming: liquids. Many 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, an assistant professor of clinical sciences at Touro University in Vallejo, California, and a spokesperson for the American Pharmacists Association.

What’s more, some drinks, foods, or substances can make a drug more or less effective or increase the risk of side effects, notes?Mayo Clinic. Here are six common drinks people living with rheumatoid arthritis should know more about.

1. 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 eye conditions such as dry eyes.

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, according to?research. “In a sense, you are getting extra drug levels that can get dangerously high in people,” says Jalloh. If you take cyclosporine or methotrexate, which may also be affected by the juice, talk to your doctor if you want to drink grapefruit juice on a regular basis.

RELATED: Rheumatoid Arthritis Medication: Beware of Sunburn if You Take These Drugs

2. 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.

RELATED:?6 Foods to Avoid When You Have Rheumatoid Arthritis

3. Willow Bark Tea

An herbal pain relief remedy used for centuries, willow bark is chemically similar to aspirin, and some studies support the use of willow bark in joint pain and osteoarthritis, notes Mount Sinai. But it can interact negatively with a number of medications. If you take methotrexate, nonsteroidal anti-inflammatory medications (NSAIDs), or blood-thinning medication, do not take willow bark. In other cases, there may be other risks or medication interactions to consider, so talk to your doctor before using this tea. Drinks like green tea and ginger tea are popular for easing pain and other rheumatoid arthritis symptoms and are likely better options.

RELATED: 10 Common Food and Medication Interactions to Avoid

4. Cola Drinks

Methotrexate-takers take note: Drinking cola may be problematic for you. A report in the British Journal of Clinical Pharmacology found that cola drinks can alter the pH of urine, making it harder for the immunosuppressant drug to leave the body. The study authors recommend that patients who are receiving high doses of methotrexate avoid having any cola drink for 24 hours before, and during administration of the drug, and until the drug has been completely eliminated from the body.

Cola drinks often also contain caffeine, which may have an impact on RA medicines such as prednisone, per the?Arthritis Foundation.

RELATED: Rheumatoid Arthritis and Caffeine: What to Consider

5. Citrus Juices

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.

6. Cow’s Milk or Dairy Drinks

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

RELATED: 8 Common Medications That May Cause Dehydration

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.

A study published in Clinical Therapeutics also found that milk may affect the absorption of NSAIDs, which are commonly used by people with RA. Authors of the research suggest not drinking milk at the same time you take your medicines, to be on the safe side.

As with most things, it’s best to consume these drinks in moderation and talk to your doctor if you have any concerns.

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Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.


  • Weiss C. Q & A: Drug Interactions With Foods and Drinks. Mayo Clinic. November 2021.
  • Hollander A et al. The Effect of Grapefruit Juice on Cyclosporine and Prednisone Metabolism in Transplant Patients. Clinical Pharmacology & Therapeutics. March 1995.
  • Facts About Moderate Drinking. Centers for Disease Control and Prevention. April 2022.
  • Methotrexate. American College of Rheumatology. March 2023.
  • Willow Bark. Mount Sinai.
  • Santucci R et al. Cola Beverage and Delayed Elimination of Methotrexate. British Journal of Clinical Pharmacology. July 2010.
  • Food and Drug Interactions. Arthritis Foundation.
  • 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.
  • Reis A et al. Drug Interaction With Milk and the Relevance of Acidifying/Alkalizing Nature of Food. Clinical Therapeutics. August 2015.

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