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ADHD Medications and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 7, 2019.

Introduction

Attention deficit hyperactivity disorder (ADHD) is a mental health disorder that can affect adults, teens, and children. Symptoms can include:

  • trouble paying attention
  • restlessness
  • hyperactivity
  • impulsive behavior

Children can have difficulties with homework, may be disruptive in the classroom setting, and have trouble getting along with others. Adult ADHD can lead to unstable relationships, poor work performance, and a low self-esteem. Genetics and the environment both appear to have a causative role in ADHD.

Treatments for ADHD typically involve medication, education, training and counseling. A combination of these options is often the most effective treatment. These treatments can relieve many symptoms of ADHD, but ADHD is a lifelong condition that can be managed, but not cured.

  • Stimulant medications, such as methylphenidate (Ritalin) and the mixed amphetamine salts (Adderall XR, Mydayis) are often used as treatment options for ADHD, but other classes are available and may be used in combination. Stimulants, used for decades for the treatment of ADHD, are effective in roughly 80% of patients.
  • The central alpha agonists such as clonidine (Kapvay, Intuniv) or guanfacine (Intuniv) are other options, as is atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor.

Alcohol Use with ADHD Medications

Amphetamine-containing medicines and methylphenidate (also called CNS stimulants) have a high risk for abuse and can cause physical and psychological dependence. A healthcare provider should review a patient’s history for signs of alcohol (ethanol) abuse or drug abuse before and during treatment with stimulants. A history of abuse may suggest greater risk for abuse with stimulants.

Teenagers and young adults may be especially at risk of drug interactions with ADHD medications if they drink alcohol. According to the CDC, most people younger than age 21 who drink report binge drinking, usually on multiple occasions.  

Important points to remember about mixing ADHD medications with alcohol:

  • In general, you should NOT use of alcohol or medications that contain alcohol while taking a CNS stimulant (like methylphenidate or the mixed amphetamine salts).
    • Certain stimulants can cause a variety of central nervous system side or heart side effects when mixed with alcohol.
    • Dizziness, drowsiness, impaired concentration or coordination, anxiety, depression and seizures may occur. Driving or operating equipment may be hazardous.
    • An elevated risk for heart problems (rapid heart rate, chest pain, heart attack) may occur when alcohol is mixed with the amphetamine derivatives (for example: amphetamine, dextroamphetamine, lisdexamfetamine). Avoid alcohol with amphetamine derivatives, especially if you have a history of heart disease.
    • If you have a history of drug or alcohol abuse, inform your healthcare provider.
  • A serious interaction may occur with certain long-acting stimulants used for ADHD (for example, Metadate CD or Ritalin LA) if combined with alcohol. In general, you should avoid alcohol while using a long-acting stimulant.
    • Alcohol may cause the medication to be released too quickly into your body and can lead to dangerous side effects and overdose.
    • In studies, when Ritalin LA was combined with alcohol at a concentration of 40%, there was a 98% release of methylphenidate in the first hour. With Metadate CD, 84% of the methylphenidate was released within the first hour.
  • Central alpha agonists, such as clonidine or guanfacine used in ADHD treatment should be avoided with alcohol. Although these products are not stimulants, side effects are still possible.
    • The combination can increase the risk of central nervous system depression, and aggravate low blood pressure, headache, changes in heart rate or pulse, dizziness, fainting, or injuries from falls.
    • Avoid driving or operating hazardous machinery until you know how the medications affect you.
  • Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor that is not classified as a stimulant. The manufacturer states that consumption of alcohol with atomoxetine did not change the intoxicating effects of alcohol.
    • Discuss the use of atomoxetine in combination with alcohol with your doctor.

Learn more: View drug interactions between ADHD medications and alcohol (ethanol)

Common ADHD Medications

Generic Name  Brand Name Examples
amphetamine Adsenzys ER, Adzenys XR-ODT Dyanavel XR, Evekeo, Evekeo ODT
amphetamine and dextroamphetamine Adderall, Adderall XR, Mydayis
atomoxetine Strattera
clonidine Kapvay
dexmethylphenidate Focalin, Focalin XR
dextroamphetamine Dexedrine Spansule, ProCentra, Zenzedi
lisdexamphetamine Vyvanse
methamphetamine Desoxyn
guanfacine ER Intuniv
methylphenidate, methylphenidate ER Adhansia XR, Aptensio ER, Cotempla XR-ODT, Concerta, Daytrana, Jornay PM, Metadate CD, Methylin, Quillichew ER, Quillivant XR, Relexxii, Ritalin, Ritalin LA, Ritalin SR

*Note: This is not a complete list; always check with your pharmacist for possible drug-alcohol interactions. Tell your healthcare providers about all the other medications you use, including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products.

Sources

  1. Product Information. Ritalin LA (methylphenidate). Quality Care Products/Lake Erie Medical, Temperance, MI.
  2. Product Information. Metadate CD Capsules (methylphenidate). Celltech Pharmaceuticals, Inc, Applegate, WI.
  3. Mendelson J, Jones RT, Upton R, et al. Methamphetamine and ethanol interactions in humans. Clin Pharmacol Ther 57 (1995): 559-68.
  4. Jiao X, Velez S, Ringstad J,  et al Myocardial infarction associated with Adderall XR and alcohol use in a young man. J Am Board Fam Med 22 (2009): 197-201.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.