Methotrexate is a medication prescribed for a variety of conditions, including autoimmune diseases like rheumatoid arthritis and psoriasis, as well as certain cancers. For individuals undergoing treatment with this drug, a common and significant concern arises regarding alcohol consumption. Understanding the potential interactions between methotrexate and alcohol is important for patient safety and treatment effectiveness.
The Primary Concern: Liver Health
Both methotrexate and alcohol are processed by the liver. Methotrexate can cause liver damage, which may manifest as elevated liver enzymes, fatty liver disease, fibrosis, and in some cases, cirrhosis. This risk is particularly pronounced with high doses or long-term use of methotrexate, and daily dosing carries a higher risk of liver damage compared to weekly regimens.
Combining alcohol with methotrexate significantly amplifies the strain on the liver, increasing the likelihood and severity of liver injury. Alcohol is a known hepatotoxin, and its concurrent use with methotrexate creates an additive or synergistic effect on liver cells. Patients on methotrexate undergo regular monitoring of liver function tests (LFTs) to detect signs of damage early.
Other Potential Health Risks
Beyond liver toxicity, combining methotrexate and alcohol can lead to other adverse effects. Gastrointestinal issues such as nausea, vomiting, and diarrhea can become more severe. Alcohol can exacerbate these common side effects, making treatment less tolerable for patients.
Alcohol consumption may also worsen other methotrexate-related side effects, including mouth sores and fatigue. Methotrexate can suppress bone marrow activity, which reduces blood cell production and weakens the immune system. Alcohol can further impair immune function, increasing the risk of infections for individuals already vulnerable due to their medication.
Navigating Alcohol Consumption While on Methotrexate
The safest approach for individuals taking methotrexate is complete abstinence from alcohol. This helps minimize the risk of serious liver damage and other adverse effects. The American College of Rheumatology advises avoiding alcohol for patients on methotrexate if kidney or liver function is not normal, as alcohol significantly increases the risk of liver damage.
If complete abstinence is not feasible, strict moderation is advised, but only after consulting with a healthcare provider. Some medical professionals may permit very limited, occasional consumption for patients on low-dose methotrexate, provided individual risk factors are assessed. Some studies suggest that consuming 14 units or fewer of alcohol per week might not significantly increase liver damage risk in rheumatoid arthritis patients. However, those with psoriasis or psoriatic arthritis may have a higher risk and should limit alcohol to no more than six units per week. Open communication with one’s doctor about lifestyle choices, including alcohol intake, is important to ensure a personalized and safe treatment plan.