Key takeaways:
If you’re prescribed methotrexate (Trexall, Xatmep), drinking alcohol with it can increase your risk of liver damage. So it’s best to avoid this combination.
If you’re a heavy drinker, methotrexate may not be a safe treatment option for you. So it’s best to be open with your healthcare team about how much alcohol you drink.
Alcohol also has negative effects on the health conditions methotrexate treats. It can increase inflammation and worsen symptoms of autoimmune conditions such as rheumatoid arthritis and psoriasis.
Save on related medications
Methotrexate (Trexall, Xatmep) is a versatile medication. It’s a chemotherapy medication that treats several different kinds of cancer. It’s also an immunosuppressant that treats certain autoimmune conditions, such as rheumatoid arthritis and psoriasis. You can take it by mouth or receive it as an IV infusion or injection.
There’s no doubt that methotrexate is an effective, life-saving medication for many people. But it also comes with risks and side effects to be aware of. A common warning if you’re prescribed methotrexate is to avoid alcohol while you’re taking it. But how bad is it to drink alcohol with methotrexate? And is just a drink or two really that big of a deal?
Here, we’ll break down how methotrexate and alcohol interact and what you should do to protect your health and get the most out of your medication.
Can you drink alcohol if you’re taking methotrexate?
No. It’s a standard recommendation to stop drinking alcohol if you’ve been prescribed methotrexate. This is true regardless of the reason you’re taking it or what formulation you’re using.
If you’re a heavy drinker, or you have trouble limiting how much alcohol you consume, methotrexate may not be the right medication for you. So it’s best to be open and honest with your healthcare team about your drinking habits. This helps them choose the safest treatment option for you. They can also help you find safe ways to reduce or quit drinking if that’s a concern for you.
Is having 1 or 2 drinks OK?
It depends. There’s not a lot of information about the risks of having a drink or two from time to time while you’re taking methotrexate. So most prescribers are cautious in their recommendations because the risk of drinking isn’t worth it.
One large study out of England looked into people living with rheumatoid arthritis who were taking methotrexate. It found that the risk of increased liver enzymes was greater in people who drank more alcohol. The greatest risk was for those who had 12 or more alcoholic drinks a week. The risk for those consuming fewer than 8 alcoholic drinks per week was the same as for those who didn’t drink at all. So it’s possible that an occasional drink may be OK if you’re taking methotrexate for rheumatoid arthritis. But it’s best to talk to your prescriber first to make sure it’s safe for your specific situation.
Keep in mind, this study was specific for rheumatoid arthritis. So we can’t assume these results apply to methotrexate treatment for other health conditions
It’s best to avoid alcohol completely if you’re taking high doses of methotrexate for cancer treatment — more detail on this next.
Why should you avoid alcohol if you’re taking methotrexate?
Methotrexate can damage your liver, especially at high doses or if you take it for a long time. In fact, you’ll take oral methotrexate just once a week in most cases because of the higher risk for liver damage if you take it every day. Alcohol itself can also cause liver damage. So combining alcohol and methotrexate raises the risk of liver problems.
Your prescriber will likely screen for liver issues before you start taking methotrexate. They’ll likely also check your liver function regularly throughout your treatment. You may have to stop taking methotrexate if signs or symptoms of liver damage appear while you’re taking it.
Methotrexate for cancer treatment
The stress of a cancer diagnosis is enough to make anyone reach for a glass of wine to take the edge off. But it’s best to find a different way to cope with stress and anxiety.
Aside from the extra stress on your liver, alcohol can worsen side effects and reduce the effectiveness of many cancer treatments. Drinking alcohol also raises your risk for developing several types of cancer. It may also increase the chance that you’ll get cancer again in the future.
If you have questions about drinking alcohol while taking methotrexate for cancer treatment, talk to your oncology team. In most cases, it’s best to avoid alcohol altogether to protect your health and increase the chance of successful treatment.
Methotrexate for autoimmune condition
Autoimmune conditions such as rheumatoid arthritis and psoriasis are caused by excess inflammation in the body. Alcohol increases inflammation in the body when you drink it. And large amounts of alcohol may worsen the symptoms of autoimmune conditions.
There’s some evidence that light to moderate amounts of alcohol may actually reduce inflammation in some autoimmune conditions. But there’s not enough information to know for sure. And if you’re taking a medication that interacts with alcohol, such as methotrexate, the risks of alcohol may outweigh the possible benefits.
Talk to your healthcare team about how much alcohol, if any, is safe for you. They can look at your medication list and overall health to give a recommendation that’s specific to you.
When can you start drinking after taking methotrexate?
Before you start having alcoholic beverages again, you’ll want to make sure methotrexate is cleared from your body. This can take up to 2 to 3 days after your final dose, and in some cases even longer. Keep in mind this timeline refers to stopping methotrexate completely — not the time in-between your ongoing doses.
You should also make sure your liver is functioning normally before you start drinking alcohol after methotrexate treatment is over. The best way to do this is to check with your prescriber. They can let you know if and when it’s OK to drink alcohol and how much is safest for you.
Are there other methotrexate interactions to be aware of?
Alcohol isn’t the only interaction to be aware of when taking methotrexate. Other examples of methotrexate interactions include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin)
Some antibiotics, such as amoxicillin (Amoxil) and Bactrim (sulfamethoxazole / trimethoprim
Folic acid (although it can have beneficial effects with low doses)
Proton pump inhibitors, such as omeprazole (Prilosec)
Medications that can harm the kidneys, such as furosemide (Lasix)
Medications that can harm the liver, such as acetaminophen (Tylenol)
Highly protein-bound medications, such as warfarin (Coumadin, Jantoven) and glipizide
Taking these medications may decrease how well methotrexate works or increase the risk of side effects. Be sure to review your medication list with your prescriber before you start methotrexate. They can look for any possible interactions and take steps to prevent them.
Frequently asked questions
Methotrexate doesn’t seem to have a direct effect on sleep. But it can cause drowsiness for some people. Other methotrexate side effects, such as nausea and mouth sores, may cause discomfort that interferes with sleep. Let your prescriber know if you’re having trouble sleeping while taking methotrexate. They can help determine the underlying cause and suggest options to help.
Yes, you typically can (and should) have routine dental work while taking methotrexate. But you should let your dental care team know that you’re taking it. They may want to take extra steps to help prevent infection as well as other issues that people taking an immunosuppressant are more likely to experience.
No natural remedy is considered a true alternative to methotrexate.
Thunder god vine (Tripterygium wilfordii) is a plant used for rheumatoid arthritis in traditional Chinese medicine. Studies show it may be as effective as methotrexate for some people. But it can be toxic to the liver and kidneys. So the risks of this herbal treatment currently outweigh the benefits. Active ingredients in supplements such as turmeric and green tea also show some benefit for rheumatoid arthritis symptoms. But these aren’t as effective as FDA-approved prescription treatments. Keep in mind that even natural supplements have side effects and interactions to consider. So be sure to check with your healthcare team before adding one to your treatment regimen.
Methotrexate doesn’t seem to have a direct effect on sleep. But it can cause drowsiness for some people. Other methotrexate side effects, such as nausea and mouth sores, may cause discomfort that interferes with sleep. Let your prescriber know if you’re having trouble sleeping while taking methotrexate. They can help determine the underlying cause and suggest options to help.
Yes, you typically can (and should) have routine dental work while taking methotrexate. But you should let your dental care team know that you’re taking it. They may want to take extra steps to help prevent infection as well as other issues that people taking an immunosuppressant are more likely to experience.
No natural remedy is considered a true alternative to methotrexate.
Thunder god vine (Tripterygium wilfordii) is a plant used for rheumatoid arthritis in traditional Chinese medicine. Studies show it may be as effective as methotrexate for some people. But it can be toxic to the liver and kidneys. So the risks of this herbal treatment currently outweigh the benefits. Active ingredients in supplements such as turmeric and green tea also show some benefit for rheumatoid arthritis symptoms. But these aren’t as effective as FDA-approved prescription treatments. Keep in mind that even natural supplements have side effects and interactions to consider. So be sure to check with your healthcare team before adding one to your treatment regimen.
The bottom line
Drinking alcohol while you’re taking methotrexate (Trexall, Xatmep) can increase your risk of liver damage. What’s more, alcohol can increase inflammation and may worsen the health conditions methotrexate treats. So in most cases, it’s best to avoid alcohol during methotrexate treatment.
There’s no clear evidence that any amount of alcohol is safe with methotrexate. If you’re taking methotrexate for an autoimmune disorder, your healthcare team may OK an occasional drink. But keep in mind that this is specific to each individual’s health and medical history. So be sure you get your prescriber’s approval before drinking any amount of alcohol.
It’s best to be open and honest with your healthcare team about how much alcohol you drink before taking methotrexate. This will help them decide if it’s a safe treatment option for you. They can also help you find safe ways to reduce how much you drink if that’s a concern for you.
Why trust our experts?
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
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