Can you drink any alcohol while taking methotrexate?
It depends on your dose, how your liver is doing, and what other medicines you take, but methotrexate can stress the liver. Because of that risk, many clinicians recommend avoiding alcohol or keeping it very low (often zero) during methotrexate treatment.
If you want a practical rule, the safest approach is to avoid alcohol while you’re on methotrexate unless your prescriber explicitly says it’s okay for you.
Why is alcohol a concern with methotrexate?
Methotrexate is processed by the liver, and alcohol can also affect liver function. Using both increases the chance of liver irritation or liver damage, which is why alcohol use is commonly restricted with methotrexate.
Alcohol can also worsen side effects such as nausea and fatigue, which can overlap with methotrexate.
What happens if you drink anyway?
Drinking alcohol while on methotrexate can raise the risk of abnormal liver blood tests and, in more serious cases, liver injury. The risk is higher if you:
- Take higher-dose methotrexate (common in some conditions)
- Have existing liver disease or heavy alcohol use history
- Take other liver-affecting medicines (some pain/arthritis meds, certain antibiotics, seizure medicines, etc.)
- Are also taking folic acid? (Folic acid is often prescribed to reduce side effects, but it doesn’t eliminate liver risk from alcohol.)
How much alcohol is “safe”?
There is no universal “safe amount” that applies to everyone on methotrexate. Some clinicians advise no alcohol at all; others may allow only occasional, small amounts if your liver tests are normal and your dose is low. The only reliable guidance for your situation is your prescriber’s advice.
What should you do if you already drank?
If you drank once or you already have alcohol on board:
- Don’t take extra methotrexate to “make up for it.”
- Contact your prescriber or pharmacist for individualized guidance, especially if you feel unwell (vomiting, right-sided upper belly pain, unusual tiredness, yellowing of eyes/skin).
- Keep up with any planned blood tests that monitor liver function.
Are there situations where you should not drink at all?
Avoid alcohol entirely (and check with your clinician) if you have:
- Known liver disease or consistently abnormal liver blood tests
- A history of significant alcohol use
- Other medications that raise liver risk
- Symptoms that could suggest liver problems
Tell me a bit more and I can tailor the advice
If you share:
1) your methotrexate dose (mg and how often),
2) what you take it for (e.g., rheumatoid arthritis, psoriasis), and
3) whether you’ve ever had abnormal liver tests or liver disease,
I can explain what factors usually matter most for alcohol guidance in that situation.