MTX and Booze — Back Together Again?
While it can be a polarizing subject, drinking alcohol is a pleasant lifestyle choice for a lot of people (including me). Not that I’ve ever been a big drinker, but my husband and I enjoy wine with dinner or meeting friends for the occasional cocktail. Since there are only the two of us, if neither of us feels like cooking, dinner sometimes consists of a glass of wine and a couple of appetizers at a nearby restaurant.
Like many people, when I was first diagnosed with RA I was put on methotrexate (MTX) and my then-doctor told me that I needed to stop drinking. I was in a high-stress career at the time and coming home and talking about my day with my husband over a chilled glass of white wine or sipping a smoky single-malt Scotch next to the fire in the winter were some of those things that helped keep me sane. I complied, but I wasn’t happy. Fortunately, I wasn’t on methotrexate long.
While alcohol can interact with many medications in various ways, the cause for concern with MTX is that both alcohol and MTX can cause liver damage. Taking them in combination seems like a toxic combination.
However, it appears that total abstinence may not be required after all.
The results of a large study
In one of the largest studies of its kind (http://ard.bmj.com/content/early/2017/03/23/annrheumdis-2016-210629), researchers in the UK looked at the risk of liver problems defined in terms of elevated AST and ALT liver tests in people who took MTX and who also drank alcohol. The elevated AST and ALT levels indicate a liver condition called transaminitis. The alcohol levels they researched were based on a weekly intake of ≤14 units of alcohol, between 15 and 21 units of alcohol, and >21 units of alcohol. (A unit of alcohol is not – unfortunately – a glass of wine, it’s 10 mL, or about 1/3 of an ounce.)
Somewhat expectedly, the study revealed the risk of transaminitis in patients with RA taking MTX does increase with increasing levels of alcohol consumption. This is not surprising because increasing alcohol on its own will increase the risk.
The surprising result is that the risk in those patients who consume ≤14 units of alcohol per week is no greater than those who do not drink alcohol. This computes to less than five ounces of alcohol per week, below the defined level of “moderate drinking” of one drink per day for women and two for men.
As with any study, there are qualifiers and limitations. For example, this study was done on RA patients but may not be directly relevant to people with psoriasis on methotrexate, because data suggests that those people, in general, have higher liver toxicity than people with RA.
And of course, if you take other medications (and which of us doesn’t), there’s always the issue of alcohol interacting with those drugs – so it’s a good thing to discuss any alcohol consumption with your doctor(s) before proceeding.
However, it’s good news for those of us who enjoy the occasional libation. If I can continue to take my methotrexate AND have a glass of wine, well, I’ll drink to that.