Cola beverage and delayed elimination of methotrexate


Dr Raoul Santucci PharmD, Pharmacy, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67098 Strasbourg, France.
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To report a case of severe delayed methotrexate elimination attributable to consumption of a cola beverage.


To investigate unexplained low urinary pH in a lymphoma patient treated with high-dose methotrexate.


Unexpected urinary acidity, despite administration of large amounts of sodium bicarbonate, could be attributed to repeated consumption of a cola beverage. It resulted in a delayed elimination of methotrexate and acute renal failure. Discontinuation of cola drinks, increase in calcium folinate rescue and in sodium bicarbonate allowed satisfactory elimination of methotrexate on day 12 after infusion and recovery from renal impairment without other severe toxicity. No other cause of delay in methotrexate elimination could be identified.


Cola beverages have a low pH due to their phosphoric acid content that is excreted by renal route. We recommend patients receiving high dose methotrexate abstain from any cola drink within 24 h before and during methotrexate administration and until complete elimination of the drug.