Should patients drink alcohol whilst taking long-term low-dose methotrexate?

Jaskiran McPhail, Senior Medicines Information Pharmacist for Patient Safety, North West Medicines Information CentreSource UKMiPublished
Topics: DosingEthanolMethotrexate

This Medicines Q&A reviews the evidence that alcohol increases risk of methotrexate-induced liver toxicity, and advises on safe levels of alcohol intake by patients taking low-dose weekly methotrexate.

  • Patients may drink alcohol whilst taking long-term low weekly doses of methotrexate (25mg or less) for skin conditions, rheumatoid arthritis and other inflammatory conditions, but they should be advised that both alcohol and methotrexate can potentially damage the liver, so they should not drink more alcohol than recommended by national guidelines (currently 14 units a week).
  • Case reports and prospective studies in patients with psoriasis, published in the 1960s and 1970s, suggest that those who drink alcohol whilst taking methotrexate are more likely to develop liver damage than those who don’t drink alcohol. Overall, published data are insufficient to show that drinking alcohol increases risk of methotrexate-induced liver toxicity. However, quality of these data is poor.
  • Use of methotrexate is contraindicated by its manufacturers in patients with alcoholism/alcohol abuse or significantly impaired liver function. However, the British Society for Rheumatology advises that methotrexate may still be an option for some patients, even if they have cirrhosis.