Alcohol Consumption and Methotrexate-Associated Hepatotoxicity

Risk of Hepatotoxicity

Alcohol consumption is a significant risk factor for methotrexate-induced hepatotoxicity, which is more common in patients with psoriasis than in those with rheumatoid arthritis 1, 3
Greater than moderate alcohol intake is specifically listed as a risk factor for hematologic toxicity and hepatotoxicity in patients taking methotrexate 2, 4

The American Academy of Dermatology and National Psoriasis Foundation define moderate alcohol use that is considered harmful as:
The British Association of Dermatologists recommends limiting alcohol intake to "well below the national guidelines" while taking methotrexate 5

Regular laboratory monitoring is essential for patients taking methotrexate, especially those who consume any alcohol:

Excessive alcohol intake is listed as a relative contraindication to methotrexate treatment 5, 7
Alcoholism is considered an absolute contraindication to methotrexate therapy 7
If a patient has a history of significant alcohol consumption before starting methotrexate, they may be at higher risk for hepatotoxicity even if they reduce their intake during treatment 3
For patients who cannot abstain from alcohol completely, consumption should be kept well below the moderate levels defined above 5

Patients with other risk factors for hepatotoxicity (obesity, diabetes, hyperlipidemia, chronic liver disease) should be even more cautious about alcohol consumption while on methotrexate 1, 3
The risk of hepatotoxicity increases with cumulative methotrexate dose, so long-term users should be particularly careful about alcohol consumption 8