Key takeaways:
If you’re prescribed methotrexate, 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 provider 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.
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Methotrexate is a versatile medication. It’s a chemotherapy agent that treats several different kinds of cancer. It’s also an immunosuppressant that treats autoimmune conditions, such as rheumatoid arthritis and psoriasis. It’s even prescribed after an organ transplant or for severe eczema.
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 just 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 form you’re using (tablet, injection, or infusion).
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 provider 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 healthcare providers 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 lowest risk was seen in those who had less than eight alcoholic drinks per week. 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 provider before you do 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. We’ll cover this in more detail 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 methotrexate just once a week in most cases because of the higher risk for liver damage if you take it every day. Alcohol can also cause liver damage. So combining them raises the risk that you’ll have liver problems.
Your healthcare provider will likely screen for liver issues before you start taking methotrexate. They’ll also check your liver function regularly throughout your treatment. You may have to stop taking methotrexate if signs 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.
Aside from the extra stress on your liver, alcohol can worsen side effects and lower the effectiveness of cancer treatments. Drinking alcohol also raises your risk for several types of cancer. And it may also raise 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 provider. In most cases, it’s best to avoid alcohol altogether to protect your health and increase the chance of successful treatment.
Methotrexate for autoimmune disease
Autoimmune diseases 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 disease.
There’s some evidence that light to moderate amounts of alcohol may actually reduce inflammation in some autoimmune diseases. 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 provider about how much alcohol, if any, is safe for you. They can look at your medication list, as well as your overall health, to give you 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 2 to 3 days after your last dose, and in some cases even longer.
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 healthcare provider. 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) sulfamethoxazole / trimethoprim (Bactrim)
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 healthcare provider before you start methotrexate treatment. They can look for any possible interactions and take steps to prevent them.
The bottom line
Drinking alcohol while you’re taking methotrexate can increase your risk of liver damage. What’s more, alcohol can increase inflammation and worsen some of the health conditions methotrexate treats. So in most cases, it’s best to avoid alcohol if you’re being treated with methotrexate.
There’s no clear evidence that any amount of alcohol is safe with methotrexate. If you’re taking low-dose methotrexate for an autoimmune disease, your healthcare provider 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 provider’s approval before drinking any amount of alcohol.
It’s best to be open and honest with your provider 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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