Liver Problem After Years of Methotrexate
from LK

Who are you?  I have had the stuff … since I was 14 years old.  I am now 57 years old.  I hate it, I hate it, I have some interesting things to share with someone. 

They are trying to tell me that I have a Liver problem.  I have taken Methotrexate for years.  Now they are telling me that because I have a drink of alcohol now and then that is why my liver is "tweaked."  I have looked at the side effects and I don't think that is the only thing that can happen. What do you think?  -LK

*****

Ed’s Response:  Liver damage is certainly the most common thing that happens when people take too much MTX over time.  This is true whether or not people drink alcohol.  Drinking alcohol may speed up the liver damage caused by MTX, but MTX is quite capable of damaging your liver even if you don’t drink.

People who drink heavily aren't prescribed MTX because liver damage is a  near certainty, and sooner rather than later. 

As you have taken MTX "for years now," your current situation may or may not have been catalyzed by alcohol consumption on top of MTX.  It certainly gives your Dr. something to blame!

Anyway, caught early, liver damage caused by MTX is reversible.  However, you may have to stop BOTH MTX and drinking alcohol to normalize your liver functions.

Hopefully, their definition of "tweaked" means your liver enzyme levels are elevated but not irremediably.  Have they said anything to you about a liver biopsy?  Many derms seek to  confirm liver damage, and its extent, by having the patient obtain a liver biopsy.  If you have been on MTX for more than two years, I would be surprised that you haven’t been prescribed a biopsy already.

In any case, elevated liver enzyme levels while taking MTX is typically received as an indication to stop taking MTX -- at least until the enzyme levels have returned to normal and stayed there for several months. 

I know a few flakers who have also been on MTX for years, had several biopsies, get their blood tested often, and continue to have no problems.  On the other hand, I've heard from scores of flakers who took MTX for some time and then stopped because of elevated liver enzyme levels. 

So, you're not alone.

Good luck and let me know what happens.  -Ed

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