INFO - Miscellaneous comments about MTX + alcohol from experts

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W. Baumgartner, M.D.

January 31, 2005

Question:

My husband injects Humira every other Saturday for RA. Is it still okay to

drink alcohol?

Dr. Baumgartner:

The main concern with alcohol and most arthritis medications is liver

toxicity. Although there have been rare associations of liver toxicity with

Humira-like medications (note recent FDA warning with Remicade, modest

alcohol consumption is probably safe with Humira [adalimumab]). Most

patients on Humira, however, take other drugs as well. Methotrexate is

commonly used with Humira, and it can be associated with liver toxicity. We

recommend little or no alcohol in patients treated with methotrexate, Arava

[leflunomide], nonsteroidal anti-inflammatory drugs and other therapies

patients may be taking can be associated with liver toxicity as well. These

should be discussed with the prescribing physician.

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Gardner, M.D.

September 6, 2004

Question:

I take 5 milligrams of methotrexate weekly and avoid alcohol the day prior

to taking it as well as the day I take it and the day after. My doctor feels

this regimen is safe enough for me to drink alcohol in moderate amounts the

other days of the week. Do you have any evidence to the contrary?

Dr. Gardner:

Use of alcohol with methotrexate makes me nervous. Both are hepatotoxic (can

damage the liver), and methotrexate is still in your system even on days you

do not take it. It is really between you and your doctor. I assume you are

getting regular liver tests. You may consider a liver biopsy if alcohol is

an important part of your lifestyle and you want to continue the

methotrexate even in low dose.

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Tesser, M.D.

May 3, 2004

Question:

How does alcohol consumption affect RA sufferers? Other than the impact on

the liver, especially if taking methotrexate, does alcohol increase the

effects (pain, swelling, fatigue) of RA?

Dr. Tesser:

Alcohol has multiple effects. In RA, it could provide analgesia and

drowsiness that initially could enhance sleep onset. But its associated

suppressant effect on the central nervous system will wear off in a period

of hours, leading to wakefulness and difficulty in falling back asleep. It

is not a good agent to use for inducing sleep, therefore. It has no direct

effect on swelling or inflammation that has been measured. It certainly

could affect the liver, contributing to inflammation and injury. The degree

would vary depending on the amount and duration of consumption and the

individual's susceptibility to it. Certainly it is not recommended on any

regular basis when someone is taking methotrexate, which can be liver toxic,

or Arava.

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Gardner, M.D.

December 15, 2003

Question:

How bad is it to drink with methotrexate? I like to have up to one glass of

wine when I get home from work to relax; how bad is this?

Dr. Gardner:

Alcohol will increase the risk of liver toxicity for methotrexate in many

people. Hopefully, your care provider has been monitoring your liver tests,

but these are not 100 percent predictive for developing liver damage. I

would have a serious talk with your rheumatologist about your use of

alcohol. There are many alternatives, besides methotrexate, that can be used

if daily alcohol is an important part of you lifestyle.

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