NutriStack
Alcohol and Leflunomide, a caution.
Leflunomide can cause clinically significant liver injury, including rare severe drug-induced liver injury. Alcohol adds hepatic stress and can make liver enzyme elevations harder to interpret, especially with regular or heavy use. The concern is highest with preexisting liver disease, elevated baseline liver tests, obesity, viral hepatitis, or other hepatotoxic medicines.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Alcohol and Leflunomide
- Pair type
- Caution
- Evidence (highest tier)
- Emerging
- Source citations
- 3 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Emerging evidence
Caution
What is happening. Leflunomide can cause clinically significant liver injury, including rare severe drug-induced liver injury. Alcohol adds hepatic stress and can make liver enzyme elevations harder to interpret, especially with regular or heavy use. The concern is highest with preexisting liver disease, elevated baseline liver tests, obesity, viral hepatitis, or other hepatotoxic medicines.
Mechanism. Leflunomide's active metabolite teriflunomide has a long half-life and can cause hepatocellular or mixed liver injury. Alcohol is metabolized in the liver and can increase oxidative stress, steatosis, and medication-metabolism burden, creating additive liver-safety concern rather than a timing-based interaction.
Recommendation. Avoid heavy alcohol use while taking leflunomide. If you drink at all, keep intake low and consistent, tell your prescriber, and do not miss scheduled liver blood tests. Stop alcohol and seek medical advice promptly for jaundice, dark urine, severe fatigue, itching, or right upper abdominal pain.
Sources (3)
- Devarbhavi H, Ghabril M, Barnhart H, Patil M, Raj S, Gu J, et al. Leflunomide-induced liver injury: Differences in characteristics and outcomes in Indian and US registries. Liver Int. 2022;42(6):1323-1329. PMID 35129282
- Alamri RD, Elmeligy MA, Albalawi GA, Alquayr SM, Alsubhi SS, El-Ghaiesh SH. Leflunomide an immunomodulator with antineoplastic and antiviral potentials but drug-induced liver injury: A comprehensive review. Int Immunopharmacol. 2021;93:107398. PMID 33571819
- Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54. PMID 10890797
Stack Score
How this pair moves the number.
Effect on the composite score
If both Alcohol and Leflunomide are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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