Using Alcohol while taking Methotrexate: Is their a risk of liver injury?

Consuming Alcohol while on Methotrexate

Methotrexate is an immunosuppressive type pill that is used in the treatment of several autoimmune hair loss conditions including alopecia areata, lichen planopilaris, frontal fibrosing alopecia, and discoid lupus. A variety of side effects are possible with methotrexate including the risk of liver toxicity. 

Alcohol Use in Methotrexate Users

Both alcohol and methotrexate can irritate the liver.  On account of this, individuals using methotrexate need to have their liver enzymes monitored periodically. Traditionally, physicians have advised patients using methotrexate to limit their use of alcohol while using methotrexate.  New data suggests that while these concepts are correct, the use of limited amounts of alcohol by methotrexate users does not appear to increase the risk of liver injury.

The UK based authors studied the effects of alcohol consumption in rheumatoid arthritis patients using methotrexate. It's important to note that these were note hair loss patient and therefore the results need to be extrapolated. The researchers studies 11 839 patients over the years 1987 to 2016. They observed that there were 530 episodes of liver enzyme elevation (i.e. "transaminitis"). The authors found that methotrexate users who consumed less than 14 units of alcohol per week did not seem to have an increased risk of transaminitis. Patients who consumed between 15 and 21 units seemed to have some degree of liver injury and patients who consumed more than 21 units had a significantly increased risk of transaminitis.

 

Conclusion

This is an important study. Many patients with autoimmune hair loss conditions make decisions on use of methotrexate based on the potential side effects and the information they are presented about the necessity to limit alcohol consumption while using methotrexate. This study provides evidence that occasional use of methotrexate is likely to be safe from the perspective of liver injury and that keeping under 14 units is also likely to have a good liver safety profile.  14 units of alcohol would include 6 glasses of wine (13 %, 175 mL) or 6 pints of beer.

Reference

Humphreys J et al. Quantifying the hepatotoxicity risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate. Ann Rheum Dis. 2017 Sep;76(9):1509-1514.