Methotrexate Foods to Avoid: Complete Safety Guide
Foods to avoid while taking methotrexate tablets: unpasteurised dairy, undercooked meat, and alcohol limits. Plus folate, supplements and what you can eat.
By Reece Douglas · Founder, FreshPlate
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Methotrexate Foods to Avoid: Complete Safety Guide
Methotrexate has no list of banned foods, but it lowers your defences against infection, so food safety matters more. The NHS says there are no specific foods you need to avoid while taking it.
This guide covers what to avoid, what to treat with care, how much alcohol is sensible, and how folate and supplements fit in. It is general information: your rheumatology, dermatology or gastroenterology team's advice comes first.
Here is what I would do. Buy pasteurised dairy only, and check the label on any soft cheese, since cooking it until steaming hot makes it safer. Cook meat until steaming hot with no pink, choose British Lion-stamped eggs, and reheat leftovers until steaming hot, eating them within two days. Keep wine, beer and spirits low, or to the limit your team has given you. Take your prescribed folic acid on the right day, add nothing extra without asking, and eat plenty of leafy greens, lentils and beans. Writing this has made me hungry! Don't forget to head over to our interaction checker if you're ever unsure!
Which foods should you avoid while taking methotrexate tablets?
Avoid unpasteurised milk and soft cheeses, because methotrexate may reduce your ability to fight infection and these foods can carry bacteria such as listeria. That is the one clear food rule from NHS guidance. Everything else below is about cooking and sourcing food safely rather than cutting it out.
Here is how the main foods compare:
- Unpasteurised milk and soft cheeses — avoid — methotrexate lowers your defence against infection, and these are a recognised source of listeria.
- Raw or undercooked meat — take care — infection risk is higher while immunosuppressed, so cook it until steaming hot with no pink.
- Raw fish and shellfish — take care — choose reputable sushi suppliers and cook other fish thoroughly.
- Raw egg in homemade mayonnaise or desserts — take care — British Lion-stamped eggs are low risk, but avoid raw egg from unknown sources.
- Grapefruit — take care — evidence is limited, but some centres advise avoiding it, so ask your team.
- Folate-rich foods — fine — leafy greens, pulses and fortified cereals are helpful and do not override the drug.
- Most normal, well-cooked meals — fine — no other foods need to be excluded.
What the experts say
“There are no specific foods that you need to avoid while taking methotrexate.”
How much alcohol can you drink on methotrexate?
Follow the limit your own team gives you; many people on a low weekly dose can drink a small amount, but some teams advise much less than the standard guideline. The NHS says it is usually fine to drink alcohol on a low weekly dose of methotrexate (25mg or less) for long-term treatment of an inflammatory condition. Alcohol and methotrexate both strain the liver, so the effects add up.
Blood tests (liver function, usually every few weeks at first, then every few months) show any problem first. If your liver enzymes are raised, expect to be told to cut right back or stop. Binge drinking is the pattern most likely to cause trouble, and it is worth avoiding even if your results are normal.
As a starting point, stay well inside the UK low-risk guideline of 14 units a week, spread across several days with drink-free days, and ask your team whether that is right for you. For a similar conversation about another medicine, see our piece on amitriptyline and alcohol.
Signs to report promptly
Tell your team or GP if you notice yellowing of the skin or eyes, dark urine, persistent nausea, or unexplained bruising. These can have causes unrelated to drinking, but they should not wait for your next blood test.
What are the best foods to eat when taking methotrexate?
Eat a normal, varied, well-cooked diet with plenty of folate-rich foods; dietary folate is fine and helpful, and does not cancel out the drug the way high-dose supplements could. There is no special methotrexate diet, but some choices make side effects easier to manage.
Methotrexate can lower folate levels, which is why many people are prescribed folic acid on a set day each week. Food folate complements that.
- Leafy greens — fine — spinach, kale and broccoli supply folate, and cooking them well also lowers any food safety worry.
- Lentils, chickpeas and beans — fine — folate plus protein and fibre.
- Fortified breakfast cereals — fine — many are fortified with folic acid, which counts towards your intake.
- Oily fish, cooked through — fine — omega-3s fit with an anti-inflammatory pattern. See our anti-inflammatory foods list.
- Plain, bland foods during nausea — fine — toast, rice, bananas and ginger biscuits are easier on days after the weekly dose.
Can you take folic acid and other supplements with methotrexate?
Take the folic acid your team prescribes, on the days they tell you, and do not add extra without asking. Folic acid is usually taken on a different day from methotrexate, and the timing matters. Very high folic acid doses taken carelessly could in theory interfere with how well the drug works for your condition.
Folate in food is a separate matter and needs no restriction.
Check with your pharmacist before starting any other supplement. This includes multivitamins with folic acid, high-dose vitamin A, herbal remedies and anything marketed as an immune booster or liver tonic. Some products add to liver strain or change how medicines behave, and labels do not always say so. Our pharmacist guide to drug-food interactions explains how to ask the right questions.
Weekly dosing, not daily
Methotrexate tablets are taken once a week. Daily dosing by mistake is dangerous, so set a fixed weekday and a phone reminder, and do not change the day of the dose to fit food planning without checking.
How to cook and shop safely when immunosuppressed
Safe handling does most of the protecting. Wash hands and surfaces, keep raw and cooked foods apart, and check use-by dates strictly. Reheat leftovers until steaming hot and eat them within two days.
If you are unsure about a soft cheese, check the label. Pasteurised brie, camembert and goats' cheese are generally the ones sold in UK supermarkets, and cooking cheese until steaming hot also makes it safer. Hard cheeses such as cheddar are not a concern.
Eating out and takeaways
Choose hot, freshly cooked dishes over buffets, deli counters and anything that has been sitting out. Ask how eggs are cooked if a dish includes homemade mayonnaise or mousse.
How FreshPlate handles methotrexate food rules for you
FreshPlate has a free food-medication interaction checker on the website: type methotrexate or a brand name and you see the foods to watch in seconds. Alcohol is the one firm rule built into the app for methotrexate: it keeps alcohol out of every recipe for you, including wine or spirits used in cooking.
Add your medicines to the app once, by brand or generic name, and every recipe it generates is built around your own medication list. The For you tab on each recipe lists your medicines and, where the interaction checker has quoted the NHS or US FDA words about food, shows them word for word with a link to the checker page. Where there is no advice on file yet, it says so and points you to your pharmacist, so you do not have to recheck every ingredient by hand without knowing where to turn.
Frequently asked questions
What foods should I avoid while taking methotrexate tablets?
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Avoid unpasteurised milk and soft cheeses, and take care with undercooked meat, raw fish, raw egg from unknown sources and grapefruit. NHS guidance says no other specific foods need to be avoided.
What foods should I eat when taking methotrexate?
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Eat a normal, varied, well-cooked diet with plenty of folate-rich foods such as leafy greens, pulses and fortified cereals. Dietary folate is safe and helpful, and does not override the medicine.
Can I drink alcohol while taking methotrexate?
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Often a small amount is acceptable on a low weekly dose of 25mg or less, but both alcohol and methotrexate strain the liver. Follow your own team's limit, as some advise much less.
Is it safe to eat soft cheese on methotrexate?
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Only if it is pasteurised and ideally cooked until steaming hot; avoid unpasteurised soft cheeses. Methotrexate may reduce your ability to fight infection, and these cheeses can carry listeria.
Should I take extra folic acid with methotrexate?
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No, not without asking your team. Take the folic acid you have been prescribed on the days they specify, and do not add more from supplements or fortified products on your own.
Sources
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