What are the interactions between Bupropion (Wellbutrin) and alcohol?

From the Guidelines

Mixing bupropion and alcohol is not recommended due to the increased risk of seizures and enhanced side effects. Bupropion, commonly sold as Wellbutrin or Zyban, is an antidepressant medication that can lower your seizure threshold, and alcohol can further reduce this threshold, potentially increasing seizure risk 1. Additionally, both substances affect brain chemistry, particularly dopamine and norepinephrine levels, which can lead to enhanced side effects when combined. Common side effects of this interaction include increased dizziness, confusion, impaired coordination, and worsened depression symptoms.

Key Considerations

• Alcohol can reduce bupropion's effectiveness as a treatment for depression or as a smoking cessation aid 1.
• If you're taking bupropion, it's best to avoid alcohol completely, especially during the initial weeks of treatment when your body is adjusting to the medication.
• If you struggle with alcohol use, discuss this honestly with your healthcare provider, as they may need to adjust your treatment plan or consider alternative medications.
• Never abruptly stop taking bupropion without medical guidance, as this can lead to withdrawal symptoms.

Important Interactions

• Bupropion can lower the seizure threshold, and naltrexone-bupropion ER should be avoided in patients with epilepsy and should be used with caution in patients with a history of seizures or with clinical factors that may increase the risk of seizures 1.
• The combination of bupropion and alcohol can increase the risk of seizures, and patients should be monitored for neuropsychiatric adverse effects, including suicidal thoughts and behaviors, especially in individuals younger than 24 years 1.

From the FDA Drug Label

1. 5 Use with Alcohol In postmarketing experience, there have been rare reports of adverse neuropsychiatric events or reduced alcohol tolerance in patients who were drinking alcohol during treatment with bupropion hydrochloride extended-release tablets (XL). The consumption of alcohol during treatment with bupropion hydrochloride extended-release tablets (XL) should be minimized or avoided.

Alcohol use with bupropion is associated with rare reports of adverse neuropsychiatric events or reduced alcohol tolerance. To minimize potential risks, alcohol consumption should be minimized or avoided during treatment with bupropion hydrochloride extended-release tablets (XL) 2.

From the Research

Bupropion and Alcohol Interaction

• Bupropion is a widely used antidepressant that can cause seizures in a dose-dependent manner, and its interaction with alcohol has been studied in several research papers 3, 4, 5, 6, 7.
• A study published in the Annals of General Psychiatry found that alcohol significantly lowers the seizure threshold in mice when co-administered with bupropion hydrochloride, suggesting a potential increased risk of seizures in patients consuming alcohol while taking bupropion 3.
• Another study published in The Journal of Emergency Medicine found that bupropion was the third leading cause of drug-related seizures, and all the bupropion-related seizures occurred in patients taking a therapeutic dose or 450 mg/day or less, with sleep deprivation, previous history of attention deficit disorder, and previous heavy alcohol use being associated with seizures in some patients 4.

Seizure Risk and Bupropion

• The risk of seizure appears to be higher with bupropion doses above the recommended maximum, and predisposing factors were noted in over half of the reported cases, according to a review published in The Journal of Clinical Psychiatry 5.
• A study published in Clinical Toxicology found that clinical features associated with seizure after bupropion overdose include QTc >500, tachycardia, and age 13-18 years, but it was not possible to identify a QTc cutoff with sensitivity or specificity to predict seizures 6.

Bupropion and Alcohol Consumption

• A study published in Alcoholism, Clinical and Experimental Research found that bupropion, alone and in combination with naltrexone, blunts binge-like ethanol drinking and intake following chronic intermittent access to ethanol in male C57BL/6J mice, suggesting a potential novel approach to treating binge ethanol intake 7.
• The same study found that bupropion dose-dependently blunted ethanol intake with "drinking in the dark" procedures and after 16 weeks of intermittent access to ethanol, and administration of subthreshold doses of bupropion + naltrexone also reduced binge-like ethanol intake 7.