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Moderate· limited-evidence
May be possible under supervision — talk to your prescriber or pharmacist before combining.
Milk thistle may affect methotrexate metabolism. While it may provide liver protection, it could also alter drug levels.
Silymarin inhibits CYP3A4 and CYP2C9, potentially altering methotrexate metabolism.
Source: Natural Medicines Database · Reviewed April 2026
Milk Thistle + Methotrexate: use caution. May be possible under supervision — talk to your prescriber or pharmacist before combining. Milk thistle may affect methotrexate metabolism. While it may provide liver protection, it could also alter drug levels.
Silymarin inhibits CYP3A4 and CYP2C9, potentially altering methotrexate metabolism.
Do not stop either abruptly on your own. Talk to your prescriber or pharmacist promptly — bring this page to your appointment.
Educational information only — not medical advice. Always verify with a healthcare professional.