Methotrexate and alcohol: Tips for you

| Elise Oberliesen

Whether you take beverages shaken, stirred or decanted, mixing alcohol with methotrexate may deliver more than a hangover. Combining the two can create a cocktail muddled with serious side effects, says Junko Takeshita, M.D., Ph.D., with the department of dermatology at the University of Pennsylvania.

"Generally, we know methotrexate can be harmful to the liver, and generally with higher doses and using it for longer [durations] that risk increases," she said.

Methotrexate is often prescribed for moderate to severe psoriasis and psoriatic arthritis. If you are struggling to avoid alcohol while taking methotrexate, here are some things to keep in mind:

Consider the risks. Takeshita said that for people taking methotrexate, risks may worsen for people with hepatitis, fatty liver disease or those who consume alcohol, since these can increase liver damage. Even though some people report drinking alcohol while on the medication, she said "everyone metabolizes methotrexate and alcohol a little differently." And for that reason, it's nearly impossible to speculate whether any amount of alcohol is safe.

Experiment with nonalcoholic drinks. Just talk to someone like Terri Eggeman, who takes methotrexate for her psoriasis and psoriatic arthritis, and it becomes clear: Navigating social situations without booze is a "hot topic." When she's out with friends or colleagues, Eggeman simply orders a sparkling water with a twist of lemon. She says it helps her feel like part of the group while it dissolves any feelings of awkwardness. Of course, turning down alcohol wasn't an issue for Eggeman, since she rarely drank anyway. But that's not the case for everyone.

Be honest with your doctor. Eggemann, who is a Psoriasis One to One mentor and visits online communities like TalkPsoriasis.org, says it's common for young adults to express frustration about a disease that hampers their lives physically. In fact, some college students forgo methotrexate all together—in favor of medicines with fewer side effects, Eggeman said.

Before the prescription pad comes out, Takeshita asks her patients to be honest about their drinking preferences.

"We take into consideration who to prescribe methotrexate to, especially if a patient says it would be difficult to manage [this medicine] with their current lifestyle," Takeshita said, noting other medications are available for psoriasis and psoriatic arthritis.


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