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On Methotrexate But Alcohol Never Mentioned
from Tony M.

Hello.  My name is Tony McManis.  I've only been to FlakeHQ a couple of times and I'm not sure how this works.  I am 30 years old and I live in Brisbane, Queensland Australia.  I have had P for about four and a half years.  I thought that I had it on a medium level, but after surfing I realise it is quite a minor case — it's all relative though. 

What I am enquiring about is methotrexate.  I started taking it about 5 weeks ago — 15mg per week.  I know that it's no good for your liver — but I drink.  I take the tablet late on Wednesday evening and I don't drink Tuesdays through Thursdays.  If I drink on Monday, I might have one or two bottles of beer.  Should I not drink at all? 

The doctor who prescribed the drug didn't even mention alcohol.  An older guy at work told me.  Are there any other bad effects associated? -Tony M.

*****

Ed’s Response:  I’ve always been advised that no alcohol should be consumed while on a methotrexate regimen.  That’s also what they say at webMD.com.

I’m really curious about the conditions under which you were prescribed MTX.  You make your P sound too minor to warrant this drug, which is one of the strongest in our arsenal and among the most dangerous.  In the treatment of P, I’ve always thought it was reserved for severe cases, often with psoriatic arthritis as a simultaneous condition.

Did your doctor draw blood for a lab work-up before prescribing MTX?  Has he said anything about periodic blood work-ups as you continue to take MTX?  Certain blood tests will flag abnormal liver functions often associated with MTX and, unless treatment is stopped (or at least adjusted) when these changes in liver function occur, your life may be in jeopardy. After you have consumed so many grams of MTX, doctors typically order liver biopsies, which are evidently more revealing than blood tests.

The good news, Tony, is that 15 mgs/weekly is a relatively low dose for psoriasis.  (For example, I just stepped down to 25 mgs/weekly after four months at 30 mgs/weekly.)

At the very least, I would encourage you to consult your doctor about using alcohol and, while you’re at it, also ask if/when blood work-ups are intended.

If you’re interested:  A journal I maintained during my first course of MTX therapy is posted here:  Dewke Methotrexate Journal.

Also, an interesting — hair-raising! — story about a liver biopsy can be read here: Rejection & When the Dr. DOESN’T Know Best.  -Ed

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