Risks of Consuming Alcohol With Humira

Humira (adalimumab) is an injection used by millions of people to manage a variety of inflammatory health conditions. Many people wonder whether it is safe to use Humira and consume alcohol. The answer to this question isn’t simple, however, because there haven’t been enough studies done. Not having sufficient clinical evidence, though, does not mean it is safe to consume alcohol with Humira.

What Is Humira?

Humira is the brand name for one of several biologic anti-inflammatory medications that inhibit TNF-alpha.

Humira is approved by the FDA for the treatment of rheumatoid arthritis (RA), polyarticular juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), Crohn's disease (CD), ulcerative colitis (UC), severe chronic plaque psoriasis, and several inflammatory eye conditions. 

In people who take Humira for RA, the treatment response is similar to methotrexate, a chemotherapy agent and immune system suppressant. In combination, the two medications increase the chances of managing RA symptoms and pain, as well as halting disease activity that causes inflammation and damage to joints, tissues, and organs.

In the conditions mentioned above, abnormal inflammation of tissues involves the actions of tumor necrosis factor-alpha (TNFα). TNFα is part of the immune system and protects the body from infection under normal conditions. However, in many autoimmune diseases like rheumatoid arthritis, the same TNFα plays a paradoxical role by producing inflammatory mediators that destroy cartilage and bone. Adalimumab binds to and neutralizes TNFα, significantly reducing inflammation and damage. However, this comes at the cost of increased risk for infection.

Humira is administered as a subcutaneous injection. That means a needle is used to inject medicine into the tissue between the skin and muscle. The cost of Humira is around $5,400 for a supply of two injections, but the manufacturer does offer financial assistance in the form of a savings card, with a small co-pay of around $5 monthly.

Side Effects

Humira is not without its side effects and adverse reactions. These may include:

• Redness and swelling at the injection site
• Itching
• Rashes
• Easy bruising
• Upper respiratory infections and sinus infections
• Headaches
• Nausea
• Pain at the injection site

Because Humira suppresses TNFα, there is a possibility it may reactivate infections, such as tuberculosis, or make it harder to fight new infections. Some infections might be fatal. In addition, there have been reports of rare adverse events when using Humira, including fatal blood disorders, an increased risk for certain cancers, liver injuries, central nervous system disorders, and cardiac failure. Anaphylaxis and serious allergic reactions are rare but possible.

Consuming Alcohol

The research on the safety of Humira and alcohol in combination is limited. However, this does not mean the combination is safe. When some medications, such as TNF inhibitors, are taken with alcohol, they may not work as effectively , or they are released into the system in higher doses. Either case may lead to severe complications.

Additionally, many patients who take Humira are also using methotrexate to treat their condition, as is the case with RA. Most healthcare professionals recommend that people taking methotrexate limit or avoid alcohol consumption even in the absence of liver disease, as summarized in a 2010 report in the medical journal Clinical and Experimental Rheumatology.

While there is a lot of conflicting information, what researchers know for sure is that alcohol, autoimmune diseases, and TNF inhibitors can damage the liver alone and in combination. In addition, other medications used to treat and manage pain associated with autoimmune conditions cause organ damage.

Liver Injury Risk

Liver enzyme elevation with TNF inhibitor use is not uncommon. In fact, studies have found elevated liver enzymes in people who use TNF inhibitors to be much higher than normal. Even though people taking Humira might have elevated liver enzymes, most won't experience symptoms. Regardless, there are reports of liver damage due to TNF inhibitor use and adding alcohol to the mix further increases that risk.

A 2013 analysis from researchers at the Indiana University School of Medicine included 34 cases of TNF inhibitor-induced liver injury. The patients in this study were taking TNF-inhibitors (including Humira) for psoriatic disease (PsA, psoriasis, or both), RA, inflammatory bowel disease or AS. Researchers found liver injury incurred within six months of the start of TNF inhibitor therapy.

Some newer research suggests TNF inhibitor-induced liver injury is rare. However, that research and other research on Humira, and/or adalimumab by another manufacturer, isn’t sufficient enough to pinpoint the effect the medication has on the liver. Additionally, they conflict with previous studies on TNF inhibitors and their effects on the liver.

A Word From Verywell

Anyone who overindulges in alcohol regularly is putting themselves at risk for chronic liver damage and other health risks. When Humira is combined with excessive alcohol consumption, the risk for permanent organ damage is very likely increased. 

Most doctors tell patients to reduce the amount of alcohol they consume or stop consumption altogether when using Humira, other TNF inhibitors, and/or other medications for managing autoimmune diseases. If it is not possible to avoid alcohol, it is important to exercise restraint in the amount consumed.

Researchers have confirmed TNF inhibitor use has been linked to liver injury, as have other medications used in combination with TNF inhibitors. People taking Humira, other TNF inhibitors, medications used in combination with TNF inhibitors, and those living with autoimmune diseases should always exercise caution in the amount of alcohol they consume. Alcohol should only be consumed as responsibly and as safely as possible.