Skip to Content

Bipolar Medications and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 9, 2019.

Introduction

Bipolar disorder is a mental health disorder that involves extreme mood swings from emotional highs and excitement (called mania or hypomania) to emotional lows and hopelessness (such as depression). Bipolar disorder has also be called manic-depression or bipolar affective disorder. The "mood swings" between mania and depression can be very sudden, and patients are at high risk for suicide.

Over 60% of people with bipolar disorder abuse alcohol or drugs. In bipolar disorder and other mental health conditions, patients are at a higher risk for alcoholism, so the potential for drug interactions can be significant.

Learn More: Bipolar Disorder: Symptoms, Diagnosis and Treatment

A variety of different medications can be used to treat bipolar disorder, and these are best used along with psychological counseling (psychotherapy). Which medications are selected are based upon specific symptoms and previous treatments. Drug treatment may be selected from these classes:

  • Mood stabilizers or anti-seizure medications such as lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro) and lamotrigine (Lamictal).
  • Atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel XR), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may be used alone or with a mood stabilizer.
  • Antidepressants are usually prescribed along with a mood stabilizer or antipsychotic. The medication Symbyax combines the SSRI antidepressant fluoxetine and the antipsychotic olanzapine into one capsule. Bupropion may be used as a second line agent for some patients with bipolar disorder. 
  • Anti-anxiety medications such as benzodiazepines may be used, typically in the short-term only, to help with anxiety, agitation and improve sleep.

Alcohol Use with Bipolar Disorder Medications

Alcohol (ethanol) drug interactions with bipolar disorder medications often result in additive drowsiness, which can be dangerous when driving or operating machinery. Because medications for bipolar disorder work in the central nervous system and affect chemicals in the brain, the addition of alcohol can also worsen side effects like dizziness, memory impairment, confusion, poor judgement, or increase risk for falls and injury. Some agents when combined with alcohol may lower blood pressure and increase the risk for fainting, a fall or injury.

The consumption of alcohol during treatment with bupropion (Wellbutrin XL) should be minimized or avoided due to side effects like seizures, hallucinations, delusions, paranoia, mood and behavioral changes, depression, suicidal thoughts, anxiety, and panic attacks.

Alcohol and certain anti-anxiety benzodiazepine medications used in bipolar disorder (for example: clonazepam or lorazepam) can result in additive dizziness, drowsiness, and depressed breathing and should never be mixed.

In general, it is best to avoid combined use of bipolar disorder medications and alcohol. If you drink alcohol frequently, discuss this with your doctor. Be sure to review each medication you are prescribed for alcohol interactions, as well as discuss possible interactions with your doctor and pharmacist. Patients with bipolar disorder who abuse alcohol can also have poor judgement, be more impulsive, and have a higher risk of injury or suicide.

Common Bipolar Disorder Medications

Generic Name Common Brand Names
aripiprazole Abilify
asenapine Saphris
bupropion Wellbutrin SR, Wellbutrin XL, Zyban
cariprazine Vraylar
carbamazepine Carbatrol, Tegretol, Equetro
clonazepam Klonopin
divalproex sodium Depakote
fluoxetine and olanzapine Symbyax
lamotrigine Lamictal, Lamictal ODT, Lamictal XR
lithium Lithobid
lorazepam Ativan
lurasidone Latuda
olanzapine Zyprexa, Zyprexa Zydis, Zyprexa Relprevv
quetiapine Seroquel, Seroquel XR
risperidone Risperdal
ziprasidone Geodon

*Note: This may not be a complete list; always check with your pharmacist or doctor 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.

Types of Drug Interactions With Alcohol

Sources

  1. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed Dec. 9, 2019 at https://www.samhsa.gov/data/report/behavioral-health-trends-united-states-results-2014-national-survey-drug-use-and-health
  2. Hunt G, Mahli G, Cleary M, et al. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis. Journal of Affective Disorders. 2016;2016: 331-349. Accessed Dec. 9, 2019 at doi.org/10.1016/j.jad.2016.07.011
  3. Product Information. Wellbutrin  (bupropion). GlaxoSmithKline, Research Triangle Park, NC. Revised 11/2019. Accessed Dec. 9, 2019 at https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Wellbutrin_Tablets/pdf/WELLBUTRIN-TABLETS-PI-MG.PDF

Further information

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