Methotrexate and alcohol

Hi everyone, this is my first post, started methotrexate 3 weeks ago and so far so good, only 10mg a week and side effects not too serious, slight nausea, stomach cramping for a couple days feeling washed out ( more than normal! ) by the 3rd day when I take the folic acid. all bearable if they get my pain and inflammation down! I have read that alcohol should be avoided? I don`t usually drink and have the odd tipple every now and then, but I am off on holiday next week and it is one of the occasions that I would normally have a little alcohol most days. Should I avoid? will it make me ill? any advice would be much appreciated. Kind regards. Shelley

15 Replies

  • hi i have been on 25mg for 10yrs plus many other drugs....i am not a regular drinker but always have some on holidays or social occasions and never had any problems although the alcohol does affect you rheumy team say its ok..this disease is cruel enough you have to have a small pleasure now and again...have a great holiday x

  • Thank you :-) I will, the steroid jab I am having tomorrow will help! although they don`t seem to work as well as they used x

  • Do a search for previous posts on MTX and alcohol as it's a popular subject! There's lots of advice.

    Generally the consensus is that moderate drinking is ok, but not more than a couple of drinks at one time. BUT....that's once you've got used to MTX and are sure that it's not affecting your liver. A lot of us (me included) didn't drink at all for the first few months on MTX. I felt it was more important that I gave myself the best chance of coping with the drugs and getting this #%^* disease under control. So maybe best to talk to your rheumy team and see what they say.

  • Hiya Shelley & welcome. I would say follow helix's advice & use the search box for this as it crops up quite often. I'm on 15 mg weekly but I'm fortunate in that alcohol doesn't like me so don't have this problem but it seems that, once you've been on MTX a while & see your liver results are steady, then having a drink in moderation is ok. I was wary anyway as when I was upped to 20mg after a bad patch my liver couldn't take it so had to come back down to 15mg.The fear I would have for you at this moment is you'll be on holiday & if you imbibe even if it's only a couple of drinks a day, having only just started MTX you have little idea how it could affect your liver & you'll be away from home & Rheumy team. Certain I wouldn't consider drinking spirits especially if it's the Med you're going to you know how large a normal measure can be lol! Maybe try what I call "cheating" drinks like low or no alcohol lager & wine if you think you'll feel left out. If you happen to be going to Spain & you like Campari try Bitter Kas, it tastes the same but without alcohol & one of my faves. Not the same effect as alcohol obviously but at least you'd be in no danger of liver problems, it can hurt, been there!!

    Have a lovely holiday & hope you reach a sensible decision for you.

  • The likelihood is that you won't find it as easy to stomach as you would have, I was quite a heavy drinker 4/6 bottles of wine a week, thankfully decided to cut this down after Christmas to drink at weekends only, still ploughed through 3 though, was diagnosed in April and wine now makes me very woosy have tried several drinks and settled on Guinness but liver is having a big rest - I was usually the last woman standing now I'm a lightweight, my friend is a liver specialist he says it's fine but obviously in moderation - ie not too many binges but we're all different. On the upside I've never felt more awake in the days but don't know if that's the drugs or the lack of wine - ha!

  • Looks like you gotta go get drunk lol, enjoy your holiday.


  • Ha ha I concur!

  • I don't wish to dampen your hols but even a small amount of alcohol on methotrexate sends my liver counts really high. We are all different, and it is your decision at the end of the day. take care and enjoy the hols.

  • Thank you everyone, I think that I am going to play it by ear, and if I do decide to have a small drink I wont have it on the day before, day of and after dose day I`m not that fussed about alcohol, just really enjoy the cocktails :-)

  • If it's not the alcohol you want & not really fussed how about trying mocktails? Just thinking cocktails are spirit based & if you're checking units a cocktail will have more units. A small 125ml glass of wine is 1.6 units & 1 x 25ml measure of spirit is 1 unit & the recommended daily units are 2-3 a day for women. I'm thinking as you're just at the start of MTX another option if you really want to drink is (if you're only on holiday for a week) have a word with your Rheumy team & ask if you could miss taking MTX for the week you're away. They might say this would be the sensible thing to do but not sure they'd sanction it if you're away longer. Worth the ask.

  • Hi Shelly,

    Hope you have a lovely holiday!

    The following is taken from the NHS National Patient Safety Agency's Oral methotrexate pre treatment patient information leaflet :


    "Methotrexate and alcohol may both cause liver damage. The

    risk of liver damage from methotrexate appears to be

    greater in psoriasis than with individuals who have

    rheumatoid arthritis. The risk is increased by alcohol. If you

    are taking methotrexate you should ensure that your alcohol

    intake is well within the maximum limits (2-3 units per day

    for women and 3-4 units per day for men)"

    I have also put a link here for you to our article on methotrexate, where you will find a section about alcohol intake and MTX

    Hope this helps


    Sally ( NRAS - helpline)

  • The advice from my consultant is that moderate drinking is fine. He classes that as a glass of wine in an evening! Personally I find it torturous! If I have one glass I really feel like I want another! Its like saying to someone who loves chocolate, here's a box but you can only eat one!!! Anyway, that's just me! Here's hoping you are fine with a few drinks and enjoy your holiday x.

  • Hi I take 25mg MTX per week and still have the odd glass or two of wine with no ill affects x

  • I have just done this. I missed my dose for a week. No difference in anything. Still couldn't get drunk and drank low alc versions rather than full xx

  • Good girl Jo lol!! Guess we're all different but I'd like to be erring on the safe side & doing the same as you if I was a drinker. Must be hard though as I've said before woe betide anyone who stops me eating choc!!!! ;)

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