Can I Drink Alcohol While Receiving Cancer Immunotherapy Like Keytruda?

Some people like to drink alcohol at times of celebration or enjoy a glass of wine with a nice meal. However, it’s important to know there’s a link between cancer and alcohol. In fact, alcohol use has been associated with raising the risk of developing certain types of cancer. It might also affect how well treatment for cancer works, including interfering with chemotherapy or immunotherapy. 

Nowadays, immunotherapy is a common treatment that people with cancer may receive for a period of time. You may be wondering if it's OK to have a drink or two while receiving this type of treatment. 

In this article, we’ll discuss whether drinking alcohol is safe while on treatment with immunotherapy and the potential risks this combination could cause. It's always best to seek your cancer specialist’s advice before drinking alcohol while in treatment for cancer.

Can I drink alcohol while receiving immunotherapy medications for cancer?

Alcohol is found in beer, wine, and liquor. It’s a carcinogen, meaning it can cause cancer in humans. Alcohol can raise your risk of different types of cancers. This includes head and neck cancers, liver cancer, and colorectal cancer. 

Examples of how alcohol can raise your risk of cancer include: 

• Causing more potential carcinogens to appear in your body after being broken down

• Raising estrogen levels in your blood (linked to breast cancer risk)

• Damaging DNA, proteins, and fats in your body

• Lowering the absorption of vitamins and nutrients in your body

Immunotherapy is a type of cancer treatment that enables your body’s immune system to better find and attack cancer cells. The immune system is your body’s natural defense against disease and infections. This is different from traditional chemotherapy, which usually works by attacking cancer cells directly. 

Immune checkpoint inhibitors are a type of immunotherapy. Examples include Keytruda (pembrolizumab), Opdivo (nivolumab), and Tecentriq (atezolizumab). They work by ramping up your body's immune system to detect and fight cancer cells better.

Is having one or two drinks OK?

In general, it’s recommended that alcohol use should be kept to a minimum, or avoided completely, while on treatment with immunotherapy like Keytruda. 

As covered above, alcohol can raise your risk of cancer. Research has found this to be the case with certain cancers, even in people who have one drink (or less) per day. This risk also applies to people who binge drink. Binge drinking is defined as five or more drinks for men and four or more drinks for women in one sitting.

Before having a drink, it’s best to talk to your cancer specialist first. They can give you guidance about what’s safe and how alcohol may affect your cancer treatment.

Are certain people more at risk when combining alcohol and immunotherapy medications?

Some people may be more sensitive to the effects of alcohol. This can potentially put them at higher risk when combining alcohol and immune checkpoint inhibitors like Keytruda.

• Older adults: People over the age of 65 are more sensitive to alcohol. Older adults tend to feel alcohol’s effects more strongly than those under 65. They’re also more likely to have accidents or injuries related to alcohol use.

• Women: Women have less body water than men. This means they may have higher blood alcohol levels even if they drink the same amount as men.

• People with liver problems: Alcohol is broken down by the liver, and it can also cause damage and added stress to the liver. Some immunotherapy medications, such as Opdivo, are also processed by the liver, and/or can affect how well the liver works. Drinking alcohol with existing liver problems while receiving immunotherapy may affect how well your cancer treatment works. It may also raise the risk of harmful side effects.

How does alcohol interact with immunotherapy medications?

Many studies have shown that alcohol use can affect parts of the immune system. More specifically, it can suppress the immune system.

While more research is needed in this area, it’s possible that alcohol’s effect on your immune system may interact with how immunotherapy medications work. Immunotherapy usually works to stimulate the immune system. So alcohol could potentially have opposing effects against immunotherapy medications like Keytruda.

This may lead to immunotherapy treatment not being able to work as well as intended if combined with alcohol use. 

What are the typical side effects?

Common side effects of immunotherapy medications like Keytruda, Opdivo, and Tecentriq include:

• Fever and/or chills

• Weakness

• Dizziness

• Nausea and vomiting

• Diarrhea

• Fatigue

• Headache

• Muscle and joint pain

• Low or high blood pressure

When combined, alcohol could worsen certain side effects of immunotherapy used during cancer treatment. That’s because alcohol can cause side effects like nausea and vomiting, dehydration, and fatigue on its own. 

Are there any serious side effects or risks?

Serious side effects of immunotherapy medications can include:

• Trouble breathing

• Swelling and weight gain

• Heart palpitations

• Higher risk of infection

• Organ inflammation in your liver, kidneys, and lungs

Alcohol use could potentially raise your risk of serious side effects associated with immunotherapy treatment. For example, both alcohol and immunotherapy medications like Keytruda can cause liver damage.

When should I get medical attention?

If any of the above serious side effects happen, seek medical help right away. If you are experiencing nausea, vomiting, and/or diarrhea that is uncontrollable you should also see a healthcare provider.

When can I start drinking after taking immunotherapy medications?

It’s important to keep in mind that alcohol use can raise your risk of cancer. This could potentially include a new type of cancer. And it’s unknown if alcohol use after treatment can raise the risk of your cancer coming back. 

It’s best to ask your healthcare provider when it may be safe for you to drink again based on your medical history.

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Written by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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