General Considerations for Alcohol and MS
For individuals with multiple sclerosis (MS), the decision to consume alcohol is more complex than it is for the general population. Beyond the general health risks of excessive drinking, people with MS must consider how alcohol interacts with their specific disease state and pharmacological treatments. A central nervous system (CNS) depressant, alcohol can temporarily worsen many of the neurological symptoms that MS patients already face, such as impaired balance, coordination, and cognition. Furthermore, alcohol is metabolized by the liver, which is the same organ responsible for processing many MS medications. This can lead to increased stress on the liver or altered drug effectiveness.
Because everyone's experience with MS is unique, there is no universal rule for alcohol consumption. Some individuals may tolerate small amounts of alcohol without any noticeable issues, while others may find that even a single drink can trigger a flare-up of their symptoms. Honesty with your healthcare provider is paramount to receiving the best advice for your personal situation.
Potential Alcohol Interactions with Common MS Medications
The most common medications for treating MS are disease-modifying therapies (DMTs), which fall into several categories, including injections, oral drugs, and infusions. While many DMTs don't have specific alcohol prohibitions listed, interactions can still occur, and the cumulative effect on organs like the liver should always be considered.
Injectable Medications
- Glatiramer acetate (Copaxone, Glatopa): Some patients taking glatiramer acetate have reported an infrequent side effect of alcohol intolerance, which can cause symptoms like flushing, nausea, or low blood pressure. While no specific direct interaction is known, both the drug and alcohol can affect liver function, so caution is advised.
- Interferons (e.g., Rebif): Certain interferons, like Rebif, can cause liver problems as a side effect. Combining them with alcohol increases the risk of liver damage and can worsen side effects such as dizziness or drowsiness.
Oral Medications
- Diroximel fumarate (Vumerity): It is advised not to drink alcohol at the same time as taking a dose of Vumerity, as it can reduce the medication's absorption. While total absorption may not be affected, timing is key. Drinking alcohol can also increase the risk of side effects like stomach upset and flushing.
- Dimethyl fumarate (Tecfidera): Similar to Vumerity, Tecfidera can cause stomach upset and flushing. Combining it with alcohol could exacerbate these issues.
- Other oral DMTs: Some oral DMTs can cause abnormal liver function or severe liver injury. A healthcare provider will likely monitor your liver function with blood tests while on these medications, and caution with alcohol is recommended.
Infused Medications
- Natalizumab (Tysabri): There is no known direct interaction between Tysabri and alcohol, but patients should be aware that alcohol can worsen MS symptoms, which may mask or complicate the recognition of Tysabri's side effects. For example, a rare side effect called progressive multifocal leukoencephalopathy (PML) has symptoms that can be similar to excessive alcohol use.
- Ocrelizumab (Ocrevus) and Alemtuzumab (Lemtrada): Infusion therapies generally have no specific warnings regarding alcohol, but patients are often advised to avoid alcohol before or during infusions. The overall risks of alcohol consumption on MS symptoms and general health still apply.
Table: MS Medications and Alcohol Interactions
| Medication Type | Examples | Key Risk with Alcohol | Notes & Recommendations |
|---|---|---|---|
| Injectables | Glatiramer acetate (Copaxone), Interferons (Rebif) | Increased liver risk, alcohol intolerance (glatiramer acetate), worsened side effects like drowsiness (interferons) | Moderate use, monitor liver function, be aware of increased sensitivity |
| Oral Drugs | Diroximel fumarate (Vumerity), Dimethyl fumarate (Tecfidera) | Reduced absorption, increased GI side effects (flushing, stomach upset), increased liver risk (some oral DMTs) | Avoid drinking at the time of dosage. Exercise caution, especially with liver function concerns |
| Infusions | Natalizumab (Tysabri), Ocrelizumab (Ocrevus) | Potential for masking symptoms of serious side effects (e.g., PML with Tysabri), general risks to MS symptoms | Moderation is generally okay, but discuss with a doctor, especially concerning symptom changes |
How Alcohol Worsens MS Symptoms
Alcohol's effects on the central nervous system can be particularly problematic for people with MS, as they can overlap with or intensify pre-existing symptoms.
- Balance and Coordination: Both MS and alcohol can impair balance and coordination. Mixing the two can lead to a dangerously magnified effect, significantly increasing the risk of falls and injury.
- Fatigue: Fatigue is a hallmark symptom of MS, and alcohol is known to disrupt sleep patterns and increase tiredness. This combination can lead to a more severe and prolonged sense of exhaustion.
- Cognitive Function: Alcohol can cause short-term cognitive impairment, such as memory lapses and trouble concentrating. For someone already dealing with MS-related cognitive fog, alcohol can compound these difficulties.
- Bladder Problems: Alcohol is a diuretic, which increases urine production. This can worsen pre-existing bladder issues common in MS, such as urinary urgency and frequency, leading to increased discomfort and inconvenience.
- Mood: Depression and anxiety are common comorbidities of MS. As a depressant, alcohol can intensify feelings of depression and negatively affect mood, potentially creating a dangerous cycle.
Alcohol and MS Comorbidities
Beyond direct symptom exacerbation, alcohol use can complicate the management of other health conditions frequently seen in people with MS. These include cardiovascular disease, diabetes, and mental health issues. Excessive alcohol intake contributes to high blood pressure and blood sugar regulation problems, which can be further complicated by some MS medications. Addressing alcohol consumption is an important part of managing overall health and controlling modifiable risk factors.
Making an Informed Decision
Ultimately, the decision to drink alcohol while on MS medication is a personal one that should be made in consultation with your healthcare team. The key takeaways are to prioritize communication with your doctor, understand your own body's unique response to alcohol, and err on the side of caution.
For many, moderation (often defined as one drink per day for women and up to two for men, though even less may be better) may be permissible. However, individuals with severe balance issues, significant cognitive dysfunction, or severe liver concerns may be advised to abstain completely.
It is important to remember that lifestyle choices, including alcohol consumption, can empower you to take control of your health and potentially protect against further disease progression and related health issues. Consider alternatives to alcohol, such as mocktails or other non-alcoholic beverages, especially if you notice a negative impact on your symptoms or find that drinking interferes with treatment adherence.
Conclusion
Navigating whether you can you drink alcohol on MS medication requires careful consideration of individual factors and open communication with your medical team. While moderate consumption might be acceptable for some, the potential for worsened MS symptoms, medication interactions (especially liver-related), and exacerbated comorbidities necessitates a cautious approach. The safest path is always to discuss your alcohol consumption with your doctor, understand the specific risks associated with your treatment regimen, and listen to your body's signals. Ultimately, prioritizing your health management and symptom control should be the guiding principle.
For more information on living with MS and managing lifestyle factors, visit the National Multiple Sclerosis Society website.
