If you are starting a biologic treatment for your psoriasis, you may wonder if it is safe to drink alcohol while you are on this medication.

People with psoriasis appear to drink more alcohol than the general population, according to researchers. One study found that 17 percent to 30 percent of people with plaque psoriasis had problems with alcohol. However, only about 5 percent of people in the United States are classified as having alcohol use disorder.

Drinking alcohol while taking a biologic can increase your risk of certain side effects, such as liver damage and infection. Consuming alcohol might also affect how well biologics work for you.

The safety of alcohol use with psoriasis treatment depends on:

• The type of medication you take
• The amount of alcohol you drink
• Your risk factors

Talk to your doctor about your alcohol intake before you start a new treatment.

Increased Risk of Liver Damage

Liver damage is one of the well-known side effects of alcohol use.

Your liver is responsible for processing and filtering substances from your blood, helping you digest food, and storing energy. Alcohol can damage your liver, decreasing liver function and making it harder for this organ to do its job. If you combine alcohol with medications that can also harm the liver, it increases the risk of liver problems.

How Do Biologics Cause Liver Damage?

The risk of liver damage with biologics is low overall but has been seen in some people. Scientists aren’t sure how certain biologics cause liver damage, but there are a few possibilities.

Biologics can increase the risk of developing autoantibodies to liver cells. These autoantibodies can attack liver cells and cause inflammation in a process similar to what occurs with autoimmune disorders like psoriasis and psoriatic arthritis.

Additionally, biologics suppress the immune system, which can reactivate hepatitis B in people who’ve had this disease in the past. Hepatitis B is a virus that attacks the liver and can eventually lead to liver failure.

Which Biologics Can Cause Liver Damage?

Some biologics are more likely than others to cause liver damage.

Tumor necrosis factor-alpha (TNF-alpha) inhibitors are more likely to cause liver damage than interleukin (IL)-23 inhibitors or IL-17 inhibitors. Liver damage may be more likely in people taking infliximab (Remicade), which prevents TNF-alpha from signaling the immune system to attack connective tissues. However, liver damage has also been seen in other TNF-alpha inhibitors, such as:

• Etanercept (Enbrel)
• Adalimumab (Humira)
• Certolizumab (Cimzia)

Although liver damage is rare with Il-17 or IL-23 inhibitors, they still carry some risk of this side effect.

Can Other Psoriasis Treatments Cause Liver Damage?

Alcohol can increase the side effects of medications that are combined with biologics to treat psoriasis. For example, consuming alcohol increases the amount of a more toxic and less effective metabolite (byproduct) of acitretin (Soriatane), a retinoid that can be used with biologic therapies to treat psoriasis.

Alcohol can also increase the risk of liver damage while taking methotrexate (sold as Otrexup, Rasuvo, and Trexall).

Increased Risk of Infection

No clinical trials (studies that test how well new treatments work in people) have evaluated the effect of biologics and alcohol, but they can both reduce your body’s ability to fight infection.

According to the Centers for Disease Control and Prevention (CDC), binge drinking is defined as consuming five or more drinks on one occasion for men or four or more for women. Drinking in excess immediately lowers your body’s ability to recognize and fight foreign invaders such as bacteria and viruses.

Chronic (long-term) alcohol use can damage your immune system, making it less able to fend off infection. Chronic drinkers have an increased risk of illnesses such as pneumonia and tuberculosis.

Because biologic therapies suppress the immune system, also increase your risk of serious infections, including tuberculosis. More research is needed to know how much a person’s risk of infection increases when they drink alcohol.

Decreased Treatment Response

People who drink excessively may not respond to treatment as well as those who don’t drink. Although more research is needed, scientists think one reason for the difference is that people who drink excessively might not take their medications exactly as prescribed.

Alcohol also may increase inflammation, making it harder to treat psoriasis. Studies show that people who drink alcohol can have increased levels of inflammatory proteins, such as TNF-alpha, compared with those who do not drink.

Alcohol Intake Recommendations

The CDC recommends limiting alcohol consumption to two drinks a day for men and one drink a day for women. A single drink may look different depending on the type of alcohol. For example, one drink is just 1.5 ounces of a distilled spirit but up to 12 ounces of beer.

Drinking less is better for your overall health. Alcohol use can increase your risk of many chronic diseases and other serious conditions, such as:

• Heart disease
• High blood pressure
• Cancer
• Liver disease
• Digestive problems
• Mental health problems
• Dementia
• Alcohol use disorder

Psoriasis and Alcohol

Drinking alcohol is associated with more severe psoriasis and an increased risk of comorbidities (co-occurring conditions). Although the type of alcohol you drink probably doesn’t matter, there may be an association between drinking nonlight beer and a greater likelihood of developing psoriasis.

Psoriasis can also increase your risk of developing nonalcoholic fatty liver disease (NAFLD). NAFLD reduces liver function, raising your risk of liver-related side effects from alcohol and biologics.

Additionally, because alcohol may make treatments less effective, drinking can lead to psoriasis flare-ups. Increased alcohol consumption is associated with more severe psoriasis and increased levels of depression and anxiety, which can also trigger psoriasis symptoms.

Talk to your health care provider about your drinking habits to make sure you are getting the best possible results from your treatment. Your doctor can also offer helpful resources if you decide you want to stop or cut back on drinking alcohol.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 114,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you taking a biologic therapy? Has your treatment led you to change your drinking habits? Share your experience with biologics and alcohol in the comments below, or start a conversation by posting on your Activities page.