Can you drink alcohol while taking methotrexate?

Bad idea. Bad idea.: Methotrexate's most serious toxicity is to the liver. You don't want to add alcohol. There's no guarantee it'll cause any problems, but do you really want to risk it? Unless your physician tell you it's okay, don't do it.

I would not ....: Recommend this for two reasons. The first is that mtx is hepatotoxic, and coincident alcohol and mtx ingestion could theoretically damage the liver. The second reason is ethanol is a diuretic (it makes you urinate) and is relatively dehydrating. Dehydration in the setting of Methotrexate could exacerbate hepatic and renal toxicity of mtx, not to mention its other ses (hair loss, mucositis, etc.).

Yes: Alcohol in modest amounts is not a significant issue.