Quick answer: Some foods and drinks affect arthritis medicines. Alcohol can add to liver strain with methotrexate and leflunomide, and to stomach bleeding risk with anti-inflammatory painkillers. Grapefruit interacts with some medicines, such as colchicine. Dairy, calcium and antacids can block absorption of some tablets. Many tablets are gentler on the stomach with food. Check your leaflet and ask your pharmacist.
Why food and drink matter
Food and drink can change how medicines are absorbed, how quickly they are broken down, and how well your stomach and liver cope with them. Sometimes the effect is small. Sometimes it matters a lot. The good news is that most issues are easy to avoid once you know about them. The patient information leaflet in your medicine box is a good starting point, and your community pharmacist can check your own combination of medicines.
This guide covers common themes. It does not list every interaction, and it does not replace advice from your prescriber or pharmacist.
Alcohol
Alcohol is the most common question people ask about arthritis medicines.
- Methotrexate and leflunomide: both can affect the liver, and so can alcohol. You will usually be advised to keep alcohol low, and your team may give you a personal limit based on your blood tests. Follow their advice.
- Anti-inflammatory painkillers (NSAIDs), such as ibuprofen and naproxen: alcohol adds to the risk of stomach irritation and bleeding. See our guide to safer NSAID use.
- Paracetamol: safe with moderate drinking at normal doses, but regular heavy drinking increases the risk of liver harm.
- Medicines that cause drowsiness, such as codeine and other opioids, gabapentin, pregabalin and amitriptyline: alcohol can make drowsiness, dizziness and falls more likely.
- Steroids: alcohol can add to stomach irritation.
For general guidance, UK low-risk drinking guidelines advise not regularly drinking more than 14 units a week, spread over several days, with some alcohol-free days. Our guides to arthritis and alcohol and alcohol guidance for arthritis go into more detail.
Grapefruit and some other fruit juices
Grapefruit and grapefruit juice can block an enzyme in the gut that breaks down certain medicines. This can raise the amount of medicine in your blood and increase side effects. Seville oranges, pomelos and some other citrus fruits can have a similar effect.
Medicines people with arthritis might take that are affected include colchicine (used for gout and pseudogout) and some medicines for blood pressure, cholesterol and other conditions. Not all arthritis medicines are affected. Check the leaflet for the words "grapefruit" and ask your pharmacist if you are unsure. If grapefruit is a problem for one of your medicines, it is usually best to avoid it altogether rather than try to time it.
Milk, calcium, iron and indigestion remedies
Calcium, iron, magnesium and aluminium can bind to some medicines in the gut and stop them being absorbed properly. These minerals are found in dairy foods, calcium and vitamin D tablets, iron tablets and many indigestion remedies (antacids).
- Bone-protecting bisphosphonates, such as alendronic acid, are taken on an empty stomach with plain tap water, and you then stay upright and wait before eating, drinking anything else or taking other medicines. Follow the timing on your leaflet exactly. Our guide to bone protection on steroids explains why these medicines are used.
- Hydroxychloroquine: antacids and indigestion remedies can reduce absorption, so leave a gap of several hours between them. Your pharmacist can advise.
- Some antibiotics, such as doxycycline and ciprofloxacin, should not be taken at the same time as dairy, calcium or iron. This matters if you are given antibiotics for an infection while on arthritis treatment.
If you take calcium and vitamin D tablets alongside other medicines, ask your pharmacist to help you plan a daily timetable.
With food or on an empty stomach?
Taking some tablets with food makes them gentler on the stomach. Others work best on an empty stomach. General patterns include:
- NSAIDs: usually taken with or after food to reduce stomach irritation. You may also be prescribed a stomach-protecting medicine. See NSAID stomach protection.
- Steroid tablets, such as prednisolone: usually taken in the morning with breakfast. Taking them in the morning also helps reduce sleep problems.
- Sulfasalazine and hydroxychloroquine: usually taken with food to reduce feeling sick.
- Allopurinol: usually taken after food, and drinking plenty of fluids is advised.
- Methotrexate: some people find taking it in the evening or with food reduces nausea. Ask your team what suits you. See our methotrexate side effects guide.
Supplements and herbal remedies
Supplements are foods in law, but some act like medicines and can interact with prescriptions.
- Turmeric and curcumin supplements in concentrated form may affect the liver and blood clotting. Cooking with turmeric is not the same as taking high-strength supplements. Read our guide to turmeric and methotrexate.
- St John's wort interacts with many medicines and can make some less effective.
- Fish oil, ginkgo and garlic supplements can add to bleeding risk alongside NSAIDs, aspirin or blood thinners.
- Echinacea and other "immune-boosting" products are best avoided unless your team agrees, because they could in theory work against medicines that calm the immune system.
Always tell your team and pharmacist about any supplements. Our medicine and supplement interactions guide covers more.
Staying hydrated and eating well
Drinking enough fluid helps your kidneys handle many medicines, including NSAIDs and allopurinol. Take extra care when you are unwell with vomiting, diarrhoea or a fever. Some medicines may need to be paused temporarily during dehydrating illnesses, but only on your prescriber's advice. A balanced diet with plenty of vegetables, fruit, wholegrains and calcium-rich foods supports your overall health while on long-term medicines. See our diet guide.
A simple checklist
- Read the leaflet for each medicine and look for food, drink, alcohol and grapefruit advice.
- Keep an up-to-date list of all medicines and supplements you take.
- Ask your pharmacist for a medicines check, especially after a new prescription. See our guide to a pharmacist medication review.
- Follow your rheumatology team's advice on alcohol limits.
- Never change the dose or timing of a prescribed medicine yourself without checking.
Frequently asked questions
Can I drink alcohol with methotrexate?
You will usually be advised to keep alcohol low because both can affect the liver. Your rheumatology team may give you a personal limit. Follow their advice and keep your blood tests up to date.
Which arthritis medicines interact with grapefruit?
Colchicine is one example, along with some medicines for blood pressure and cholesterol. Check the leaflet for each medicine or ask your pharmacist.
Should I take ibuprofen or naproxen with food?
Yes, anti-inflammatory painkillers are usually taken with or after food to reduce stomach irritation. Some people are also prescribed a stomach-protecting medicine.
Can I take calcium tablets at the same time as my other medicines?
Calcium can reduce absorption of some medicines, such as bisphosphonates and some antibiotics. Ask your pharmacist to help you space them out.
Is cooking with turmeric safe on methotrexate?
Using turmeric as a spice in food is generally considered fine. Concentrated supplements are different, so talk to your team before taking them.
Sources and further reading
This guide is for general education and is not a substitute for personal medical advice. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.