Can You Drink Alcohol With ATTR-CM?
Published on July 7, 2026
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Note: While research on alcohol is evolving, the World Health Organization says drinking less or not at all is better for your health.
If you have transthyretin amyloid cardiomyopathy (ATTR-CM), a rare type of heart failure that occurs when irregular proteins build up in your heart, you may wonder if it’s safe to drink alcohol.
Because alcohol can make heart failure and its symptoms worse, most experts say it’s best to drink as little as possible with ATTR-CM. “Alcohol acts as a cardiotoxin, meaning that it's like poison to the heart muscle,” says Sarah Paciulli, RN, a family nurse practitioner at the VCU Health Pauley Heart Center and cardiac amyloidosis clinic in Richmond, Virginia.
Alcohol also prompts your liver to make more transthyretin (TTR), the protein that causes ATTR-CM, says Andres Carmona Rubio, MD, a cardiologist specializing in heart failure at Cleveland Clinic in Ohio. “Alcohol feeds the process causing your condition and works against your medications."
How Alcohol Affects ATTR-CM
ATTR-CM makes the walls of your heart thick and stiff, and reduces its ability to pump enough blood through your body.
Alcohol directly damages heart muscle cells, which can make ongoing amyloidosis worse, says Dr. Carmona Rubio. Amyloidosis is a general term for abnormal protein buildup in your organs; in the case of ATTR-CM, it involves TTR, which affects your heart. Worsening protein buildup can exacerbate some ATTR-CM symptoms, such as shortness of breath and swelling in your legs.
“For patients with ATTR-CM, drinking alcohol is discouraged,” says Paciulli. “Even in small amounts, it can place extra stress on an already compromised heart.”
It Affects Your Blood Pressure
Alcohol temporarily lowers blood pressure, and ATTR-CM damages the nerves that adjust for blood pressure changes. So when you drink, your heart can’t adjust, and sudden low blood pressure can cause dizziness and fainting, says Carmona Rubio.
It Boosts Your Risk of Arrhythmia
Alcohol can irritate the heart's electrical system, increasing the risk of dangerous heart rhythms, says Cynthia A. Kos, DO, a cardiologist at the Advanced Heart Failure Center at Hackensack Meridian Jersey Shore University Medical Center in Neptune, New Jersey. “For a heart that is already stiff and struggling to pump, a sudden, fast, or irregular heartbeat can be too much to handle.” This can lead to life-threatening heart problems.
Arrhythmias like atrial fibrillation can make you feel tired, dizzy, breathless, and like your heart is pounding or fluttering. When you have ATTR-CM, people with atrial fibrillation have a very high risk of developing blood clots, says Carmona Rubio.
Blood clots can cause heart attack, stroke, and pulmonary embolism (a blood clot that travels to the lungs). All three of these complications can be life-threatening.
It Causes Fluid Retention
Drinking alcohol tells your body to hold on to water. When you have ATTR-CM, you have a more fragile fluid balance, and extra water can cause swelling in your legs and fluid in your lungs. More fluid in your lungs can make it hard to breathe, and leg swelling can lower your mobility.
It Dehydrates You
While drinking alcohol with ATTR-CM can lead to too much fluid in your body, you can also easily get dehydrated with this condition, says Paciulli. Because it’s hard for your body to maintain a balanced fluid level with ATTR-CM, medications may remove too much fluid too fast. Alcohol also dehydrates you, which adds to this risk.
“When you're dehydrated, your blood pressure can drop,” says Dr. Kos. “For a heart that is already weak, trying to pump blood when there isn't enough fluid and the blood pressure is too low is a huge strain.”
Dehydration with ATTR-CM can also make you feel weak and dizzy, increasing your risk for falls, says Paciulli.
Does Alcohol Interact With ATTR-CM Medications?
Alcohol interacts with a few different medications you may take for ATTR-CM, says Paciulli. Talk to your doctor about how alcohol may affect your specific medications.
Here are some common ATTR-CM medications and how alcohol can affect them.
Medication Type
Medication Examples
How Alcohol Affects Them
Blood thinners
warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto)
Increases your risk of life-threatening bleeding
Water pills (diuretics)
furosemide (Lasix), metolazone (Zaroxolyn), hydrochlorothiazide (Microzide, Hydrodiuril, Oretic)
Lowers blood pressure too much and increases dehydration
Blood pressure medications
midodrine (ProAmatine, Orvaten), droxidopa (Northera)
Lowers blood pressure too much
Nerve pain medications
pregabalin (Lyrica), gabapentin (Neurontin)
Makes you extra drowsy
TTR silencers
vutrisiran (Amvuttra)
May make the medication less effective
SGLT2 inhibitors
bexagliflozin (Brenzavvy), canagliflozin (Invokana), dapagliflozin (Farxiga)
Increases dehydration and risk of very low blood sugar levels
Are Some Alcoholic Drinks Safer for ATTR-CM Than Others?
No research has shown how different types of alcohol affect ATTR-CM, but in general, some drinks may be safer than others.
“To be clear, we do not recommend any alcohol consumption,” says Paciulli. “Having said that, dry red wine would be favored over other options.” Dry red wine contains plant compounds called polyphenols, which can act as antioxidants and help prevent inflammation, says Paciulli.
But the quantity matters much more than which type of alcohol is consumed, says Paciulli. “The risks go up with heavier use,” says Paciulli.
If you don’t want to give up alcohol altogether, Paciulli recommends sticking to no more than one drink per day for women and no more than two drinks per day for men. These limits are considered moderate alcohol use for anyone, with or without ATTR-CM.
Safe Drinking Practices for People With ATTR-CM
More and more research shows that there is no "safe amount" of alcohol for anyone, says Paciulli, who recommends avoiding it altogether if you get diagnosed with ATTR-CM.
“Every drink introduces a risk that a heart with structural problems may not be able to handle,” says Kos. “This is a tough but important conversation to have with your physician.”
If you choose to drink, our experts recommend these steps to stay safer.
- Limit your alcoholic drinks to one or less per occasion.
- Have a drink two to three times per week, maximum.
- Stay hydrated before and after having a drink.
- Weigh yourself the next morning and report any changes to your provider, which can help you catch fluid buildup early.
Carmona Rubio also recommends avoiding alcohol if you feel any of these ATTR-CM symptoms that alcohol could make worse.
- Shortness of breath
- Dizziness when standing
- Irregular heartbeat
- Nerve pain in your hands or feet
If you have any questions about if and when you can drink alcohol and how much, ask your provider. “Living with a chronic condition like ATTR-CM can be challenging, and it's normal to want to continue enjoying the things you love,” says Kos. “Don't be afraid to talk to your healthcare team about your concerns and your lifestyle. We are here to support you.”
Resources We Trust
- Mayo Clinic: Amyloidosis: Symptoms and Causes
- Cleveland Clinic: Are Some Alcoholic Drinks Healthier?
- National Institute on Alcohol Abuse and Alcoholism: Alcohol-Medication Interactions: Potentially Dangerous Mixes
- AlcoholAwareness.org: Why Alcohol Causes Belly Bloat and Water Retention
- Johns Hopkins University: Alcohol and Heart Health: Separating Fact From Fiction
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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Meet Our Experts
Cheng-Han Chen, MD, PhD, FACC, FSCAI
Medical Reviewer
Cheng-Han Chen, MD, PhD, is the medical director of the structural heart program at MemorialCare Saddleback Medical Center in Laguna Hills, California, and director of structural a...
Abby McCoy, RN
Author
Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is...