Humira & Alcohol

There are lots of drugs that occasionally mess up liver function. That’s very different from an interaction with alcohol, or a risk that’s exacerbated by alcohol consumption. You’ll probably do fine on Humira, and if you do have side effects they’re very unlikely to be substantially better if you’ve sworn off alcohol. Good luck!

Since I have been on the cousin biologic Remicade, my GI doc has put me on a "2 drinks a week" cap, due to liver chemistries concerns. I am not  a huge drinker and it probably averages out to 2 drinks a week anyway, but I have occasionally exceeded that cap in one sitting on vacations or at special events. At a small gathering just last week, I had around 5 glasses of wine.

The only time I have ever had liver chemistries issues was with methotrexate that was being taken with Remicade because it suppresses renal elimination of Remicade. Since being taken off Methotrexate, I have had no liver chemistry issues. We tinkered with my methotrexate dosage before taking me off completely, and it was unquestionably the culprit as I went right back to normal after going off it and my drinking habits didn't change at all. 

You may want to be careful with your consumption of alcohol because it adds another toxin to the list of what you are bombing your liver with, but unless and until your liver chemistries get out of whack- and they will be tested regularly- I wouldn't worry about it too much. If you start trending into abnormal numbers, they will start asking about stuff like this, what other meds you are taking and what other substances you are putting in your body.

If Humira becomes a viable long term remedy for you, it is very appropriate to have these kinds of concerns. Although I somewhat agree with your doctors that it's not really an issue until testing shows it's an issues.  And not all livers are created equal- some can take tremendous toxin abuse from the host and function very well for a long time.

@CTBarrister posted:

Since I have been on the cousin biologic Remicade, my GI doc has put me on a "2 drinks a week" cap, due to liver chemistries concerns. I am not  a huge drinker and it probably averages out to 2 drinks a week anyway, but I have occasionally exceeded that cap in one sitting on vacations or at special events. At a small gathering just last week, I had around 5 glasses of wine.

The only time I have ever had liver chemistries issues was with methotrexate that was being taken with Remicade because it suppresses renal elimination of Remicade. Since being taken off Methotrexate, I have had no liver chemistry issues. We tinkered with my methotrexate dosage before taking me off completely, and it was unquestionably the culprit as I went right back to normal after going off it and my drinking habits didn't change at all. 

You may want to be careful with your consumption of alcohol because it adds another toxin to the list of what you are bombing your liver with, but unless and until your liver chemistries get out of whack- and they will be tested regularly- I wouldn't worry about it too much. If you start trending into abnormal numbers, they will start asking about stuff like this, what other meds you are taking and what other substances you are putting in your body.

If Humira becomes a viable long term remedy for you, it is very appropriate to have these kinds of concerns. Although I somewhat agree with your doctors that it's not really an issue until testing shows it's an issues.  And not all livers are created equal- some can take tremendous toxin abuse from the host and function very well for a long time.

Thanks, CT.  (Btw I have lurked on many of your posts in this group and found a lot of them tremendously helpful and uplifting.  And at times hilarious!  So thanks for that as well.)  

My initial plan was to go on Stelara (which has no known liver issues/impact) but my insurance company raised their cheapskate hands and put a stop to that (despite a peer review from Mt. Sinai affirming its suitability).  If I fail as a Humira candidate for some reason, my insurance will cover the Stelara, but I have to try Humira first (since Cigna is in bed with Abbvie). So it goes.  

I am going to play ball, clean up my act for a bit, give the Humira a chance to succeed/fail and then slowly reintroduce my bad habits.    If it doesn't end up proving successful for me, maybe I land on Stelara after all.  

Thanks again, and be well!

Thanks and Good luck, njd. I am not sure how much you drink but it's less likely to be an issue than whatever drugs you might be taking with Humira. The general question raised by this thread is a good one for all people taking Remicade or Humira. In the distant past, I also had liver chemistry issues when I was put on Imuran. I was taken off of it very quickly. You should know I was on Remicade and Methotrexate for around 3 years before any issues started appearing in my blood work. During those 3 years my drinking habits remained unchanged from what they were before I started Remicade. They probably average out to a few drinks a week, but I will go weeks without drinking and then go away on vacation and drink a lot. When I was with my girlfriend in Maine a couple weeks ago, her drinking habits drove mine, which is how it works some time. We drank heavily the first two days, wine and cocktails mostly, and by the third day I was swearing off drinks to her slight disappointment. She had bought a couple of bottles of wine and put them in the hotel fridge and I just didn't feel up to it, and I also didn't indulge in the booze cruise we went on on the 3rd day. It was not so much worry about my liver chemistries as I woke up hungover the 3rd day and drinking all day affects my energy motor. My girlfriend has a super high energy level especially on the vacations we have gone on, and to match her I need to not drink a lot. Although I would say my liquor tolerance is a lot higher than hers is as far as inebriation.

As J-Pouchers go, I am admittedly a pretty heavy drinker.  I am a homebrewer and beer nerd, and generally have 2 pints a day; more on weekends.  My liver has never shown any signs of strain from that before, but the only medications I've ever really been on longterm have been Cipro (jives just fine with alcohol), Entocort (same), and Flagyll (theoretically compatible, but in practice, just two sips of beer would make me want to throw up!).

So biologics are new territory for me.  Hence the concern and apprehension.  Would like to hang on to the rest of my organs, to the extent I can!  

I'll be sure to check back in and update this thread with my anecdotal results once a couple doses and rounds of bloodwork are under the belt.  

@njd posted:

As J-Pouchers go, I am admittedly a pretty heavy drinker.  I am a homebrewer and beer nerd, and generally have 2 pints a day; more on weekends.  My liver has never shown any signs of strain from that before, but the only medications I've ever really been on longterm have been Cipro (jives just fine with alcohol), Entocort (same), and Flagyll (theoretically compatible, but in practice, just two sips of beer would make me want to throw up!).

So biologics are new territory for me.  Hence the concern and apprehension.  Would like to hang on to the rest of my organs, to the extent I can!  

I'll be sure to check back in and update this thread with my anecdotal results once a couple doses and rounds of bloodwork are under the belt.  

 

Just to correct one thing: Flagyl isn’t “theoretically compatible” with alcohol - it comes with a strong warning against using alcohol while on it. Some people get away with the combination and do fine, but that’s just luck.

I think what Scott posted is correct as to the alcohol warning on Flagyl, but in the past I got bombed out of my mind while taking cipro and flagyl. Like njd, I never had any issues mixing alcohol and antibiotics. I also never had any serious side effects of any kind with antibiotics, other than they made me prone to yeast infections.

But that flagyl warning I think is based on mixing the two substances (flagyl and liquor) and having a reaction to the mix, and not based on possible liver damage from mixing. In any event, I was lucky on ducking any issues or side effects mixing alcohol with flagyl and now Remicade.

Oh, yes.  Totally agree with you both!  That Flagyll warning is there with good cause.  My surgeons took the position of "go ahead and try; some folks have no problem with it."  I learned that I am certainly not one of those folks!  Flagyll alone makes the room spin for me.  No need to pour any gas on that fire!  (I only ever go on Flagyll when it's pretty clear Cipro is no longer working, and I need a gut biome reset.)  

In my honest opinion, I think you should give up alcohol. It is known that alcohol kills the good bacteria and causes an overgrowth of the bad bacteria in the small intestine. Alcohol has a lot of negativity with it, I think you should give it up but it is entirely your choice.

CT is correct that the Flagyl/alcohol interaction has nothing to do with liver damage. 

While there are some bacteria that act as true pathogens (C. diff, Salmonella, Shigella,...) most bacteria are neither good nor bad. There seem to be healthy mixtures and less healthy mixtures of bacterial species, and the science is still evolving on this. It may be a very long time before this is figured out for J-pouchers. It is certainly *not* “known that alcohol kills the good bacteria and causes an overgrowth of the bad bacteria.” Alcohol abuse kills many, many people, but plenty of J-pouchers enjoy moderate alcohol consumption without a problem.

@njd posted:

Hi all,

I am about to start Humira after 22 years with a J-pouch, managing chronic pouchitis and frequent obstructions with Cipro for most of that time; occasional bouts with Flagyll (woof, no thanks!) and Entocort (worked great, but I got hooked!  took a year to taper off, and back onto Cipro). 

One thing I have heard is that Humira potentially can do a number on your liver.  So I am wondering about the safety and others' experiences consuming alcohol while on Humira.  Questions to my docs about this have all been sort of side-lined with a general "Hey, let's not worry until we see bloodwork that gives us a reason to," and Abbvie's website is almost negligent in it's ducking of the issue.  I'd like to head into it with better info, or at least some opinions, one way or the other.

Has anyone had any experience with this?  Should I quit drinking entirely before going on Humira?  Are you on Humira and drink alcohol regularly?   

Any thoughts along this line are greatly appreciated.  I

Be well; stay well; and get even better, y'all.

-njd

U.C. Dx July 1998
Toxic Megacolon Dx August 1998
Colectomy Fall 1998 (32 days in the hole, and ten cumulative days in ICU!)
Reconnected April 1999

*Talking directly to njd* A lot of people are going to be for alcohol on here, its proven that alcohol wrecks gut health. Give everything I said previously some thought. I think every J-poucher should not drink alcohol in addition to everyone, especially IBD folks. If you do not believe me I would suggest going without alcohol and see for yourself how better things are. A lot of J-pouchers agree that they do better without it. A lot of people on here shut down what I say without even researching it/asking about it or even trying it. Its totally up to you if you want to try and see. I hope you do try, good luck with everything

CT Barrister- when you got off Methotrexate, did you replace with another med to keep you from developing antibodies against Remicade? Another-wards, is there another option? 

Brewbirds, there were replacement options, but my doctor elected not to replace methotrexate and I take my Remicade now straight up but not on the rocks. It may be that some years had passed with no development of antibodies. My Doc did mention he wanted to test my Remicade levels. The methotrexate's job was to prevent renal secretion of the Remicade such that your blood levels of Remicade aren't therapeutic. I had that test done while on Methotrexate and my levels were good. But it hasn't been checked in a couple of years. However, my scope was done on June 29 and it looked better than last year, so we know the Remicade is working.