Alcohol consumption during low-dose weekly methotrexate therapy

Q: UK Medicines Information summarises the evidence for this frequently asked question: Can patients drink alcohol while taking long-term low-dose methotrexate?

This content was published in 2009. We do not recommend that you take any clinical decisions based on this information without first ensuring you have checked the latest guidance.

A: Patients can drink alcohol while taking long-term low weekly doses of methotrexate (25mg or less), but they should limit their intake.

Evidence suggests that consumption of alcohol increases the risk of liver toxicity. The risk of liver fibrosis or cirrhosis is 2.5 to five times greater in patients who drink more than 12.5 units of alcohol per week than those who drink fewer. However there are insufficient data to establish what amounts of alcohol patients can safely consume without causing damage.

Methotrexate is usually unsuitable for those suspected of alcohol misuse or with a history of liver disease, especially if caused by alcohol. It should not be given to patients with significantly impaired liver function.

National guidelines recommend that patients taking low-dose weekly methotrexate (by any route of administration) should ensure their consumption of alcohol is well within maximum national limits (two to three units a day for women and three to four units a day for men, with at least one or two alcohol-free days per week).

Patients with psoriasis or psoriatic arthritis should not drink more than six units of alcohol per week because they may have a higher risk for liver toxicity than those with other inflammatory conditions.

This FAQ is taken from a “Medicines Q&A” produced by UK Medicines Information. The full document, including references, is available from First published 16 April 2009, expires 30 April 2011

Last updated
Clinical Pharmacist, CP, 2009;()::DOI:10.1211/PJ.2021.1.71672

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