Can you drink alcohol on methotrexate? Sometimes, but it's your rheumatologist's call, not a yes-or-no rule. US methotrexate labels warn that heavy drinking raises the risk of liver damage, and the American College of Rheumatology says to avoid alcohol. UK guidance says drinking is usually OK on a low weekly dose. Your liver tests and your doctor decide.
We read the methotrexate tablet, injection and auto-injector labels on DailyMed, the National Library of Medicine's drug label database, on November 2, 2026. They don't all use the same words.
This article is general information, not medical advice. It covers low-dose methotrexate taken once a week for conditions like rheumatoid arthritis and psoriasis. Talk with your doctor or pharmacist before you drink or change anything about your doses.
Can You Drink Alcohol on Methotrexate?
Here's what each source says.
| Source | What it says about alcohol |
|---|---|
| Methotrexate tablets label (Trexall and generics) | Liver risk "is increased with heavy alcohol consumption." Tell your provider if you drink, and if the amount changes. |
| Generic methotrexate injection label | "Avoid drinking alcohol during Methotrexate Injection treatment." |
| Otrexup auto-injector label | "Do not drink alcohol while taking Otrexup." |
| American College of Rheumatology (2025 patient page) | "Alcohol should be avoided as it can significantly increase the risk for liver damage while taking methotrexate." |
| NHS (UK) | "It's usually OK to drink alcohol" on a low weekly dose for a long-term inflammatory condition. On high doses, ask your doctor. |
| 2017 study of 11,839 people with rheumatoid arthritis | Up to 14 UK units a week: liver-test problems at about the same rate as in people who didn't drink. |
The common thread is the liver. The labels, the American College of Rheumatology and the 2017 study all tie heavier drinking to liver risk on methotrexate. Where sources split is light drinking. That's the part your rheumatologist settles, using your liver blood tests and your health history.
Why Do Doctors Give Different Advice About Methotrexate and Alcohol?
If your doctor said "a little is fine" and the pharmacy or the leaflet said "never," you're not imagining it.
A 2017 study in the Annals of the Rheumatic Diseases laid out the history. American College of Rheumatology guidelines from 1994 recommended no alcohol, with only occasional exceptions. British guidance from 2008 told patients to stay "well within the UK national recommendations." The authors added that "different rheumatologists and healthcare practitioners may give different advice on what is safe."
Rheumatologist Jack Cush, MD, wrote on RheumNow that the rules he heard from colleagues ranged from "lips that touch liquor shall never touch methotrexate" to "just not on the same day."
The labels add one more layer. The same methotrexate tablet label covers cancer treatment as well as rheumatoid arthritis and psoriasis, so it speaks to everyone who takes the drug. Your doctor's advice is about you, including your liver tests.
How Much Alcohol Can You Drink on Methotrexate?
No US methotrexate label we read gives a number of drinks. The closest thing to a number comes from research.
The 2017 study followed 11,839 people in the UK who started methotrexate for rheumatoid arthritis. It looked for liver enzyme results three or more times above the normal limit and grouped people by how much they said they drank each week:
- Up to 14 UK units a week, the risk was about the same as for people who didn't drink.
- At 15 to 21 units, the authors saw what they called a "possible increased risk."
- Above 21 units, the risk was about 1.85 times that of non-drinkers.
The study counted UK units. One UK unit is 8 grams of pure alcohol, so 14 units is 112 grams. A US standard drink has about 14 grams, so 14 units works out to about 8 US drinks a week, and 21 units to about 12.
That doesn't make 8 drinks a week a safe limit for you. The study only included people with rheumatoid arthritis. It measured blood tests, not liver scarring. It relied on what people said they drank. The authors wrote that their results "cannot be automatically generalisable" to other groups, such as people with psoriasis.
Older research looked at liver biopsies instead. A 1991 review of 15 biopsy studies covering 636 people on long-term methotrexate called at least 100 grams of alcohol a week "heavy" drinking. That's about 7 US drinks. Advanced liver changes showed up in 17.8% of those heavy drinkers vs 4.5% of the others.
Take these numbers to your rheumatologist as questions, not as a limit you set for yourself.
Can You Drink Alcohol on Methotrexate Injections?
Same medicine, different wording.
The generic methotrexate injection label says, "Avoid drinking alcohol during Methotrexate Injection treatment." The Otrexup label says, "Do not drink alcohol while taking Otrexup." The tablet labels talk about "heavy alcohol consumption" instead.
The tablet labels do not tell you to avoid alcohol. That isn't permission to drink. They still warn about heavy drinking, and they ask you to tell your provider if you drink and if the amount changes.
Every label we read ties alcohol to methotrexate's liver risk. The Otrexup and Rasuvo labels both list alcoholism, alcoholic liver disease and other chronic liver disease as reasons not to use the drug at all. If you just switched to shots after taking pills and the new leaflet sounds stricter, ask your rheumatologist whether your alcohol advice changed too.
Can You Drink Alcohol After Your Methotrexate Dose?
Can you drink the night of your dose, or a day later? Should you skip a week for a party?
None of the labels we read sets a rule about drinking on or near your dose day. (The generic injection and Otrexup labels' advice against alcohol covers your whole treatment, not one day.) The 2017 study counted drinks per week, not which day they fell on. Day rules come from individual doctors. Dr. Cush lists "just not on the same day" among the policies he has heard. His own rule for people with rheumatoid arthritis is that alcohol "should not be a part of your daily routine."
If your doctor gave you a day rule, follow it. If you're thinking about skipping or moving a dose to make room for drinking, call your pharmacist or prescriber first. If you've already missed a dose, see what to do after a missed dose of methotrexate. If a moved dose ever ends up taken two days in a row, here's what to do first. For other medicines, see how long to wait after alcohol.
Can You Drink at a Wedding or Holiday Party on Methotrexate?
A plan made before the event beats a worried search the morning after.
- Ask before the event, not after. The tablet label asks you to tell your provider if the amount you drink changes during treatment, and a holiday season or a wedding weekend is that kind of change.
- Bring three questions: Is any alcohol OK for me right now? If so, how many US standard drinks, and over what time? Does my dose day matter?
- Count standard drinks, not glasses. A big pour or a strong beer can count as two (see the table below).
- If drinking is part of your job, say so. Dr. Cush reminds patients that "there may be alternative medications wherein alcohol use is not in question."
| Drink | Size | Alcohol by volume | US standard drinks |
|---|---|---|---|
| Regular beer | 12 oz | 5% | 1 |
| Strong beer | 12 oz | 10% | 2 |
| Wine | 5 oz | 12% | 1 |
| Spirits (vodka, whiskey) | 1.5 oz | 40% | 1 |
Source: NIAAA, "What Is A Standard Drink?"
What Happens If You Drink Alcohol on Methotrexate?
The worry here is your liver over time.
Methotrexate on its own "can cause severe and potentially irreversible hepatotoxicity, including fibrosis, cirrhosis, and fatal liver failure," the tablet label warns. Hepatotoxicity means liver damage. Heavy drinking adds to that risk. The label also tells your provider to check your liver with blood tests before and during treatment, and to hold or stop methotrexate if needed. For people with psoriasis, the label adds that scarring "may occur in the absence of symptoms or abnormal liver tests."
If you already drank more than you meant to: don't take anything extra to "fix" it, and don't skip or move your dose on your own. Tell your rheumatology team, and ask whether they want to check your liver tests sooner.
Call your provider if you notice any of these signs of liver problems, listed in the methotrexate tablet Patient Information: tiredness; swelling in your legs, feet or ankles; easy bleeding or bruising; weight loss; loss of appetite; itchy skin; nausea; yellowing of your skin or the white part of your eyes; difficulty thinking clearly; or weakness.
Is a High Liver Test on Methotrexate Always From Alcohol?
Not always. Alcohol is one possible reason, so be honest about it, but there are others.
Methotrexate itself can affect the liver.
Weight, diabetes and fatty liver matter too. The Otrexup label says people with "obesity, diabetes, hepatic fibrosis or steatohepatitis" are at higher risk of liver injury from methotrexate. A 2010 study of 518 people with inflammatory diseases, tested while on methotrexate or before starting it, linked signs of liver scarring to a body mass index over 28 and to high alcohol use, not to how long people had taken the drug.
Other medicines count as well. The American College of Rheumatology says methotrexate rarely causes liver issues, and they are most likely in people who already have liver problems, use alcohol, or take other drugs that are toxic to the liver. Bring your full medicine list to your provider, including pain relievers like Tylenol, which has its own alcohol and liver rules.
How Pillo Helps With a Weekly Methotrexate Schedule
A once-a-week medicine is easy to forget when plans change. Pillo lets you set the exact day your dose is due, and its persistent alarm keeps going until you deal with it, so a busy weekend doesn't push your dose aside.
Use Dose Notes to jot down what you drank around a dose, so you have real numbers when your rheumatologist asks. Appointment Management keeps your blood test dates in the same app. Pillo is free for unlimited medications, with ads.
FAQ
Is alcohol riskier with methotrexate if you have psoriasis?
It may be. The tablet label warns that in psoriasis, liver scarring can happen without symptoms or abnormal liver tests. In a 1991 biopsy review, advanced liver changes showed up in 7.7% of people with psoriasis vs 2.7% of people with rheumatoid arthritis. That gap counts everyone in each group, drinkers or not. Dr. Cush writes that he allows no alcohol for people with psoriasis or psoriatic arthritis on methotrexate. Ask your dermatologist or rheumatologist what applies to you.
Does starting methotrexate mean you can never drink again?
Not necessarily. Some doctors say no alcohol at all, and others allow a little, based on your liver tests and other risks. The 2017 study's authors worried that unclear rules lead some people to avoid methotrexate "altogether" and miss its benefits. Ask about alcohol at your first visit, before your first dose.
How long after stopping methotrexate can you drink?
Ask the doctor who stopped it. The answer depends on why you stopped and what your last liver tests showed. Don't stop methotrexate on your own to make room for drinking. That's a treatment decision to make with your rheumatologist.
Does this apply to a one-time methotrexate shot for an ectopic pregnancy?
This article is about low-dose methotrexate taken once a week for arthritis, psoriasis and similar conditions. A one-time shot for an ectopic pregnancy, or methotrexate for cancer, comes with its own instructions. Ask the team that gave it.
Can you drink alcohol on other arthritis medicines?
It depends on the medicine. See Aleve (naproxen) and alcohol for pain relievers and allopurinol and alcohol for gout. On meloxicam? See how long it takes to work and turmeric and meloxicam.
A Note on Medical Advice
This article is for informational purposes only and does not constitute medical advice. Consult your doctor or pharmacist for advice specific to your medications. If you notice yellowing of your skin or eyes, or other signs of liver problems while taking methotrexate, contact your healthcare provider.
