Alcohol and MTX and Arava | Arthritis Information

Hi,

I don't post much but hope someone can help. I take MTX, Arava and Prednisone for RA. I was always a moderate to heavy drinker. In Australia it's now deemed heavy drinking if over 2 standard drinks in a session, so at 6-10 means I'd be classed as an alcho. Still would have many, many friends in that category.

I tried to stop drinking with the meds but I really do enjoy drinking. Pretty stupid I guess with the warnings but so be it. I try and be careful, only drink Fri, Sat and Sun but mainly try for only 2 days and try very hard to stop at 4 per session. Though generally fail and get to 6 on each of those days. Then have MTX on a Tuesday so make sure at least two days after drinking.

One doc didn't seem to concerned at drinking but said it's to much and cut back to 2 per day. Another said try and stop but didn't seem to concerned. All my liver tests to date have been fine or only very slightly elevated. Have been doing this for a couple of years so far. I know another person whose been on MTX for over a decade and never stopped drinking. Now has elevated liver results but just monitors it.

I've tried to get research on long term drinking effects with those meds but can't find anything concrete. Yes they say you shouldn't as MTX and alcohol and coffee and tea and...... are all irritants. But come on I'm going to try and live as well. However there is no long term research that shows drinking and MTX lead to "X" number of deaths/damaged livers.

So can you point me to some decent research or if you've been drinking for an extended period on MTX can you pass on your findings. If I can pass on any further info just let me know.

do a google scholar search for methotrexate and alcohol or liver damage You get over 25,000 hits for the mtx and alcohol search.

the combo of mtx and arava is a bad one when looking at its affect on the liver. Adding alcohol at the level you have may not be the smartest idea and I wonder that your drs are so blase about it. However I understand that under Aussie rules you may not qualify for a medication change as it appears the combo is controlling your disease.

You mentioned you already had elevated liver function tests....is drinking really that important to you that you continue to risk permanatly damaging your liver. You cannot compare someone elses results to yours. Their bodies react differently than yours...your 6 drinks may be the equivilant of their 2 drinks. Look at your test results...elevated liver function tests say either quit drinking or change meds...going on as you are only means your liver continues to receive damage.

buckeye2009-11-22 06:42:56I'll be blunt, stop the drinking............ or restrict it to a 1 session of four a week.

I really can't talk, I smoke so in the end it is you that has to make the call.
All the best with what ever way you go.

Thanks but I don't use google for that level of info, hence the reason for asking if anyone had links etc to research. I already said drinking may not be the smartest but wanted some actual research data. Maybe the docs are not overly concerned as, there's no real supporting data and my liver tests are ok. Won't even go there with your inference of medication change. My understanding is liver count can be up from moderate coffee drinking as well.

So thanks for the reply but I was actually after informed comments based on research.

Thanks Bodak,

Your right we all have our vises and mine is to calm the mind and numb the pain with a few drinks. I'm trying to find research that proves that I'm doing long term damage. Best I can find is that excessive drinking and drinking around the day of the tablet can be an issue. Also that drinking may reduce the effects of Methotrexate but it appears no research specific to effects of drinking on liver with MTX. If there is any around hopefully someone can point me in the right direction.

no offense Austravel but you wanted us to do your research. There are over 25000 scholarly articles concerning MTX and alcohol use...these are articles available on PubMed as well....

drink..don't drink I really don't care..its your liver but don't claim there is no evidence of potential damage because the information is available if you only cared to look

Austravel,

It seems that you want some more scientific responses so I talked with Charlie Brunnell down at the local bar. He is usually passed out, head on the bar by 10:30 PM every night. I asked him about alchohol and arava and methotrexate and he said that it's okay to drink while on those medicines. I hope this information is helpful.

LEV

levlarry2009-11-23 07:10:30

Aaaaah I get it, another clicky forum with the usual smart asses and those that are obvious experts that like to speak condescendingly to others. Funny I thought due to the nature of this forum it would be different but it appears the kiddies are allowed to play on all sites

I gather you don't think asking for information is research, I certainly hope you are an expert in every field and have never, ever asked for assistance or help. Better to google I guess. I'm pretty good at research in my engineering profession in fact work with researchers every day. I gladly pass on info on multiple sites in my field. Never have I done what you guys do but then I generally never get to the post numbers you guys have, tell you something?

I'd hoped someone could have either given me links or told me places to access the papers. Funny you say there are heaps of publications out there with data proving not to drink with these meds. A number of the doctors I've asked have said there is anecdotal evidence but didn't think there was specific research done. Hence my question. Do you know for instance that the advice on drinking with these meds is different in each country, Aus, UK and US? Now why would that be if there was as you say a huge amount of literature available based on research. In fact one of the specialist I visit said.. ahhh forget it, waste of time!

I stated it probably wasn't smart to drink but I like to, didn't need condescending smart asses to belittle my decision. Guess what I'll bet there are also those on these meds that drink coffee, tea (both not advisable), smoke, are over weight, don't exercise, etc, etc. Get the picture! But not only would it appear that you guys would never do this but are just a wealth of information, but not willing to share. Just in case you don't get it that's sarcasm, in fact I'll bet it's the opposite.

So thanks guys but..........................

Austravel, this hasn't been an issue for me, as I have maybe one glass of wine every six months.

I've always been told that MTX and alcohol was a complete no no.

From memory, it has to do with upsetting our liver emzymes somehow. If that happens evidently it renders our system unable to respond to any of the anti rheumatic drugs (DMARDS).

Since DMARDS are our primary medication to beat the high imflammation, rebalance our immune systems and stabilise our RA, it's kind of important that our liver emzymes are kept happy, alcohol supposedly does a lot of damage in that area.

As for research and anecdotal evidence, I can't be much help there but it seems most Rheumatologists recommend the MTX and no alcohol guideline.

Hope this helps in some way. Cordelia2009-11-24 05:46:13 [QUOTE=levlarry]Austravel, Thanks CordeliaWhen I was in college, I asked my dr. I played on various teams and was in a sorority, so there were multiple parties. He said that one a week would be ok. Basically, he said your liver can only handle so much. He also said that it could be fine for years, and then pop up with elevated enzymes. That is why we get blood tests so often-try to catch a problem before it gets too serious.

Really, it's a personal choice. My dr. gave me the facts as he knew them, I was left to make the decision. Now I will have a drink occasionally with friends after work, but not regularly. I have been on MTX since I was a teen-that's alot of work for one liver!

[QUOTE=Austravel]Thanks Cordelia[/QUOTE]

No worries, Austravel.

I get the feeling from what you said that you use alcohol as a way to let off steam as a response to stress and it has become your primary coping mechanism.

Maybe you could reduce some of the alcohol you drink regularly and look for other ways that would help you release the stress so that your coping response is not solely based on when and how much you drink, so you feel better.

None of this would be easy from your point of view, I imagine, change like that is never easy or comfortable to face.

I hope you sort out what is right for you.

Thanks Rocckyd.

Hi Cordelia,

You'd be right there. I do have a few drinks to reduce stress, but also I'm one of those people that a few drinks changes my mood, for the better. I'm a very serious person due to pressures at work and home (health etc). A few drinks lets me relax, my problem is one is never and has never been enough. Like other peoples vises, I really do enjoy a drink, I don't have to drink every night nor until I'm a drooling mess. However half a dozen standard drinks to numb the pain (both sorts) and calm me down is my get away. Now some may say that's a tad sad to need booze for an escape. But again it's like any other vise that most have and it's hard to stop using a crutch when it's been there for a very long time. It's not easy to give up because it's something I really do enjoy. To sit down with my wife, friends or family and have a few drinks is great. To sit on a beach or in the bush around a camp fire and have half a dozen drinks, damn does it get any better, well not in my books at least.

However yes you are right I need to make some big decisions. Thanks for your email.

Austravel, I've been on MTX for a year. I like to drink too, but due to weight issues (pounds slowly creep on me) I can't drink every night. I keep it to weekends and have as much as I want. So far liver tests are fine, I feel that there will be time to deal with it if and when problems appear. I'm tested every three months, and my doctor is of the "up to you" school. The worst thing about drinking and RA is the fact that alcohol helps tremendously with the pain. It would be tough to give it up, as I so look forward to those weekends with that extra relief.

Hi there,

I was told that I could drink two drinks a week (2 beers, 2 glasses of whine, 2 shots etc). I pretty much stay within those boundaries but there are some occasions that make it difficult to for me to respect a two-drink maximum....sitting around a campfire being one of them. I have allowed myslef to drink a bit more than I should have. During a party when alcohol is flowing freely, it is difficult to keep track of how many glasses of wine I have had...especially when the host is bending over backwards trying to make sure everyone's glass is full. My liver enzymes have never been elevated...or at least I have never been informed that my liver enzymes have been elevated (I trust my RD so I think it's the former rather than the latter).

I waited until i was finished university to start MTX. I was doing fine on gold injections but I definetely wanted to wait untill I was out of university to start this drug. There were way to many parties and, as dumb as this might sound, alcohol was too much of an important factor in my life at that point in time. I would have been completely miserable if I could not have fully participated in the initiation, the law games...celebrated with my buddies when we passed the bar. So I waited. I started a couple of years after and I remember my first New Years Eve...it sucked.

Anyhoo...I'm going on and on....all I want to say is that I understand you. I dont think I have the same dependancy as you but I do feel it is an immense sacrafice that I havent quite come to terms with. When my doc suggested Arava and mentionned a few moments later, after having gone through all the side effects, that I could drink...I must have had a huge grin on my face because he said :"geez...I should started with that".

Be careful Austravel...the last think you want is to have a problem with your liver.

[QUOTE=Austravel]Hi Cordelia, Thanks fuzzywuzzy,

True about not wanting liver problems.

I guess it is a dependancy but we all have them just depends on which one you have. I'm trying your 2 glass limit at a time. It's at least a start I guess. Might have to talk with the doc to see if I can swap the MTX to something else, though it works pretty well so I can't see it happening. Probably the worst thing is going from a lifestyle where I could drink when ever I wanted to this has really hurt.

Bodak [QUOTE=Austravel]Thanks fuzzywuzzy, [QUOTE=Austravel]Thanks fuzzywuzzy,

True about not wanting liver problems.

[/QUOTE]

Arava is actually harder on your liver than the MTX...

True...but for some reason or another...drinking while on Arava is OK.

I agree with those of you who said having a drink or two is something that I just don't want to give up. We are retired and it has become part of our lifestyle. (It helps me cope with the ups and downs of RA as well.)

From the posts, it sounds like some of you think it is safer to drink with Arava than Methtrexate? What have your doctors' said? My nurse practioner said "low amounts" of alcohol are okay. This was before I was actually taking Arava. Now that I decided to start it, I need to ask what "low amounts" actually mean. Switched to Arava in June as Methotrexate didn't agree with me. I dropped the Arava to 10 mg every other day about a month ago and have notice very little difference on how I feel. Will be confessing up when I go in on December 15th. I just want to have some control while still staying on track with my treatment. Also get Orencia infusions every four weeks. The combination of the two work better than the Orencia alone. (I tried that for about a year.)

Hope you all had a nice Thanksgiving!

Sharon

Exactly, it's more of a life style for me as well. I still function but a few drinks after a long day or around a camp fire is just great. I might give your idea of alternating Arava a go. I'm on pretty high dosage I guess, 20mg MTX, 20mg Arava and 3mg Pred. I'm told the RA indicators are all normal and never have shown I have RA. So based on symptoms and my grandmother and uncle having RA it's been deemed I have as well. So no blood work evidence, nor joint problems just a lot of pain. I've tried dropping the pred back to 2mg but no way can I cope. I'm come to grips with taking high level drugs to keep the pain partially at bay but to stop a few drinks of an afternoon 2-3 times over the weekend is almost impossible. Especially when we travel, pull up and set up the humble abode and it just goes well sitting with a drink and admiring the view. I know it's a risk but then I could be hit by a bus tomorrow. So this is the sort of discussion I'd hoped for but would also love to see any research that anyone knows of. I'm talking about research specific to damage levels (on average) to those on these medications. I've only see research that makes the link of chemicals that irritate the liver, ie MTX, alcohol, coffee. So they are all irritants but of course MTX and alcohol makes it worse.

So here's another thought. If your liver levels are ok does that mean you are tolerating MTX and alcohol ok and can continue with what you are doing or can there still be small amounts of long term damage happening?? This I've asked of 2 specialists, and the answer is maybe it's causing damage but they were not sure, again as there appears to be little conclusive research, or is it that they are are clueless.

Austravel,

Have all the same questions you do. It seems impossible to get any concrete answers. Sometimes I feel one way and then the other myself. I know I do want to enjoy life while I'm still living. I, too, lead a pretty normal life....but I have lost some of my dexterity and cannot do things that require a "tight grip." After 40 years of RA, guess that's not too bad. Try to tell myself I have a lot to be thankful for, but there are those days when it gets to me. I guess when it comes down to it, we all have to make our own personal decisions about what drugs to take. Take care!