Can I consume alcohol while taking Vumerity (diroximel fumarate) for multiple sclerosis?

Vumerity and Alcohol Consumption

There is no specific contraindication to consuming alcohol while taking Vumerity (diroximel fumarate) for multiple sclerosis, but moderation is strongly advised—limit intake to no more than 1-2 drinks per day, as alcohol may exacerbate gastrointestinal side effects and potentially affect liver function.

Key Considerations for Alcohol Use with Vumerity

No Absolute Contraindication

• Vumerity's prescribing information and clinical trials do not list alcohol as an absolute contraindication 1, 2, 3
• Unlike medications such as methotrexate or bedaquiline where alcohol avoidance is explicitly recommended, fumarates do not have this restriction 4

Gastrointestinal Tolerability Concerns

• The primary concern with combining Vumerity and alcohol is worsening of gastrointestinal symptoms, which are already the most common side effects of fumarate therapy 3
• Diroximel fumarate was specifically developed to reduce GI adverse events compared to dimethyl fumarate, with 46% fewer days of significant GI symptoms 3
• Alcohol can independently cause gastritis, nausea, and abdominal discomfort, potentially compounding the GI effects of Vumerity 4
• In clinical trials, GI-related discontinuation rates were low (0.8-1.6%), but adding alcohol could increase this risk 3

Hepatic Monitoring Considerations

• While Vumerity does not cause significant hepatotoxicity in most patients, liver function should be monitored as part of routine MS care 2
• Excessive alcohol consumption can independently cause liver dysfunction and should be avoided in any patient on chronic medication 4
• If you choose to drink, limit consumption to no more than 1 drink per day for women or 2 drinks per day for men (consistent with general medical recommendations) 4

Metabolic Effects

• One case report documented ketonuria in a patient with type 1 diabetes taking dimethyl fumarate (the parent compound), suggesting potential metabolic effects 5
• While this is rare and specific to patients with diabetes, it highlights that fumarates may affect cellular metabolism in ways not fully understood 5
• Alcohol can also affect glucose metabolism and ketone production, creating a theoretical concern for additive metabolic effects 5

Practical Recommendations

Safe Alcohol Limits

• No more than 1 standard drink per day for women, 2 for men 4
• One standard drink = 12 oz beer, 5 oz wine, or 1.5 oz distilled spirits 4
• Always consume alcohol with food to minimize GI irritation 4

When to Avoid Alcohol Completely

• During the initial titration period of Vumerity when GI side effects are most common 2, 3
• If experiencing active GI symptoms (nausea, diarrhea, abdominal pain) 3
• If liver function tests become elevated 2
• If you have pre-existing liver disease, gastritis, or peptic ulcer disease 4
• During pregnancy or if attempting to conceive 4

Monitoring Strategy

• Track GI symptoms carefully, especially in the first 2-3 months of therapy 2, 3
• Monitor liver function tests as clinically indicated 2
• If GI symptoms worsen with alcohol consumption, eliminate alcohol entirely 3
• Report any persistent nausea, vomiting, or abdominal pain to your healthcare provider 2

Common Pitfalls to Avoid

• Do not assume that because alcohol is not explicitly contraindicated, it is completely safe—the combination may still worsen tolerability 3
• Do not drink alcohol on an empty stomach while taking Vumerity, as this increases GI irritation risk 4
• Do not exceed moderate drinking limits, as excessive alcohol has multiple adverse health effects independent of MS medication 4
• Do not ignore worsening GI symptoms—if alcohol makes symptoms worse, discontinue alcohol consumption 3