Can You Drink Alcohol When Taking Arthritis Drugs?

Caution may be needed when drinking alcohol with certain arthritis medications like methotrexate, Tylenol (acetaminophen), and nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen). The risk varies with the amount you drink as well as the type and dosage of drug you take.

In general, a person in good health should limit alcohol intake to no more than one drink a day for females and no more than two drinks per day for males. This may not be true if you have underlying liver disease, kidney disease, and a history of stomach ulcers. In such cases, you may need to abstain or speak with your healthcare provider to determine which amount is "safe."

This article looks at the effects of alcohol with different arthritis medications and what you can do to avoid toxicity and injury to your liver and other vital organs.

Alcohol Can Interact With Methotrexate

Methotrexate (MTX) is the generic name for the brand name drugs Rheumatrex, Trexall, Otrexup, and Rasuvo. Healthcare providers commonly prescribe MTX for people with rheumatoid arthritis (RA) to reduce pain and swelling and slow the progression of this autoimmune disease.

Historically, people taking MTX were advised to abstain from alcohol as the combination increased the risk of hepatotoxicity (liver poisoning) and liver damage. The American College of Rheumatology continues to support the guidance, affirming the risk of liver injury.

Even so, a 2017 analysis published in the Annals of Rheumatic Diseases reported that moderate drinking appears to be OK when taking MTX. The study, which included 11.813 adults, suggested that consuming no more than 14 standard drinks per week may be acceptable in people with no underlying liver problems.

For its part, the National Health Service in England suggests that it is "usually OK" to drink alcohol in moderation if you take a low weekly dose of MTX (25 milligrams or less). Anything higher the 25 milligrams should be discussed with a healthcare provider.

As a general rule, speak with your healthcare provider before taking alcohol in any form with MTX.

Alcohol Can Produce Erroneous Liver Test Results

Drinking alcohol can produce erroneous results because it can alter markers of liver function in the blood. This can lead your physician to prescribe the wrong dosage of medication, which can cause a variety of unintended effects that would depend on your specific case.

Alcohol and NSAIDs

Even drinking alcohol with over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can cause complications.

Patients taking Tylenol (acetaminophen) regularly should be cautious about their alcohol use. For the average healthy adult, the recommended maximum daily dose of acetaminophen is 4,000 milligrams (mg), but in some people, doses close to the 4,000 mg daily limit could still be toxic to the liver. Therefore, it’s safest not to exceed 3,000 mg per day, especially for people with lower body weight.

In addition, alcohol causes the liver to convert acetaminophen into more toxic byproducts than if you were to abstain. As a result, it’s important to take the minimal amount of acetaminophen necessary, as well as limit alcohol consumption while taking acetaminophen.

Overuse of alcohol with NSAIDs can also increase the risk of stomach ulcers. Patients who take ibuprofen (Motrin) or aspirin (Bayer) are usually safe if they drink a small amount of alcohol, according to information from the National Health Service.

However, exceeding the recommended dosage of either medication increases the risk of irritating your stomach lining. In combination with NSAIDs, drinking alcohol also increases this risk and may lead to internal stomach bleeding.

If you have liver or kidney problems, do not take aspirin or ibuprofen unless your healthcare practitioner tells you it is safe to do so.

Alcohol Impacts Other Symptoms

Finally, many patients with arthritis also have fibromyalgia, a disorder associated with widespread musculoskeletal pain and other distressing symptoms, including mood issues, fatigue, and memory problems.

Drinking alcohol in the evening may adversely affect the quality of sleep. Poor sleep can increase the symptoms of fibromyalgia such as fatigue, pain, headaches, and depression. It is best for fibromyalgia patients to avoid drinking later in the day if sleep medications are prescribed due to potential interactions.

Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology, and a member of the American Medical Association. Dr. Zashin is the author of Arthritis Without Pain: The Miracle of Anti-TNF Blockers and co-author of Natural Arthritis Treatment.