NutriStack
Alcohol and Methotrexate, a caution.
Alcohol can add to methotrexate's liver toxicity risk, especially with regular or heavy use. The risk is most important for people with rheumatoid arthritis taking long-term low-dose methotrexate, people with abnormal liver tests, obesity, fatty liver disease, viral hepatitis, or other hepatotoxic medicines. Occasional low intake may be lower risk, but repeated intake makes liver enzyme monitoring more important.
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 Methotrexate
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Alcohol can add to methotrexate's liver toxicity risk, especially with regular or heavy use. The risk is most important for people with rheumatoid arthritis taking long-term low-dose methotrexate, people with abnormal liver tests, obesity, fatty liver disease, viral hepatitis, or other hepatotoxic medicines. Occasional low intake may be lower risk, but repeated intake makes liver enzyme monitoring more important.
Mechanism. Methotrexate can cause dose- and exposure-related hepatocellular injury through antifolate effects, mitochondrial stress, and inflammatory injury pathways. Alcohol independently increases hepatic oxidative stress and can worsen steatosis or hepatitis, creating additive liver risk rather than a timing-based interaction.
Recommendation. Avoid heavy drinking while taking methotrexate. If you drink alcohol at all, keep intake low and consistent, tell your prescriber, and do not skip scheduled liver blood tests. Stop alcohol and seek medical advice if you develop jaundice, dark urine, unusual fatigue, or right upper abdominal pain.
Sources (2)
- Humphreys JH, Warner A, Costello R, Lunt M, Verstappen SMM, Dixon WG. Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate. Ann Rheum Dis. 2017;76(9):1509-1514. PMID 28341765
- Kremer JM, Weinblatt ME. Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate. Ann Rheum Dis. 2018;77(1):e4. PMID 28596184
Stack Score
How this pair moves the number.
Effect on the composite score
If both Alcohol and Methotrexate 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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