- Addiction & recovery
Bupropion and Alcohol – The Risks
July 19, 2021
The prolonged or excessive use of any addictive substance is dangerous as it can cause severe health effects, withdrawal, and overdoses. However, the risks are even higher when two or more substances are combined or when a substance is consumed while under the influence. This practice, known as polysubstance use, is one of the main causes of substance misuse-related emergency room visits and deaths in the U.S. and worldwide. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2011 DAWN report, more than half of all alcohol-related emergency room visits also involved illicit substances and prescription medications. And more than 80% of all synthetic opioid-related overdose deaths also involved alcohol.
Polysubstance use can be deliberate or unintentional. It can also include any combination of substances such as fentanyl and heroin or prescription opioids and benzodiazepines. However, the most common combination usually involves alcohol. The widespread acceptance and use of alcohol make alcohol the common denominator in most polysubstance use. And one of the substances that are commonly combined with alcohol is bupropion.
What Is Bupropion?
Bupropion is an antidepressant medication approved by the U.S. Food and Drug Administration (FDA) to treat Major Depressive Disorder (MDD), Seasonal Affective Disorder (SAD), and nicotine addiction. Bupropion helps improve mood and feelings of well-being, reduces cravings and the withdrawal effects of nicotine. Bupropion is available in three different formulations: immediate-release, sustained-release (SR), and extended-release (XL). The FDA has approved the SR form in the United States to treat depression under the brand name Wellbutrin SR and for smoking cessation under the brand name Zyban. It’s also used off-label to treat conditions such as:
- Attention deficit hyperactivity disorder (ADHD)
- Social anxiety disorder
- Post-traumatic stress disorder (PTSD)
- Certain forms of nerve pains
How Does Bupropion Work?
Bupropion works by influencing the production of certain neurotransmitters responsible for transporting messages between neurons in the brain. It improves mood, concentration, and attention by blocking the absorption of dopamine, serotonin, and norepinephrine and thus increasing their production. Bupropion is also believed to block some of the brain chemicals that react with nicotine to prevent the effects of smoking, reduce cravings, and minimize nicotine withdrawal symptoms.
The exact mechanism of bupropion in managing conditions such as depression, SAD, and nicotine addiction is complex and partly understood. However, it’s considered unique to other antidepressants since it’s a norepinephrine-dopamine reuptake inhibitor (NDRI). NDRI is a new formulation of antidepressants that rarely generate the side effects such as weight gain and sexual dysfunction older antidepressants are known to cause. Bupropion is usually prescribed along with other antidepressants to counteract the sexual dysfunction caused by such medications.
What Is Alcohol?
Alcohol is a substance produced through the fermentation of grains, fruits, or other sources of sugars. It’s the main ingredient in wine, liquor, and beer and is a legal, psychoactive substance that plays a social role in many communities. Thousands of people habitually use alcohol to relax, socialize and celebrate. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 85.6% of adults aged 18 years and older admitted to drinking alcohol at some point in their lives.
Despite the widespread acceptance of alcohol, it’s a harmful substance due to its ability to cause various health complications. Alcohol misuse is one of the major risk factors for liver damage, heart disease, stroke, and digestive problems. And the leading cause of preventable deaths and disabilities in the U.S. and worldwide.
How Does Alcohol Work?
Alcohol is a central nervous system depressant that works by increasing the effects of neurotransmitter gamma-aminobutyric acid (GABA) and decreasing the levels of the neurotransmitter glutamate. When consumed in large quantities, it can cause depressant effects and slow down neural activity, brain functions, and various other vital functions. However, alcohol can also influence the release of dopamine and trigger stimulant effects when taken in small quantities. Such stimulant effects usually appear when the blood alcohol content (BAC) is around 0.05 mg/l and can soon be replaced by the depressant effects once the BAC reaches 0.08 mg/l.
The effects of alcohol tend to vary from person to person based on several factors, including:
- Body chemistry
- Physical and mental health
- Medical conditions
- Polysubstance use
- Level of tolerance
Bupropion and Alcohol – The Risk of Seizures
Epileptic seizures are one of the rare but serious side effects of bupropion. The condition is most likely to occur in people who:
- Have an eating disorder
- Have a history of seizures
- Have an underlying condition that causes seizures
- Are prescribed to take high doses of the medication
The risk of developing the condition is even higher in people who combine alcohol with bupropion or indulge in excessive alcohol consumption while on bupropion. This interaction affects brain chemicals and triggers seizures that can be particularly distressing. However, the risk remains the same when a person tries to quit drinking after a prolonged period of combining an alcoholic drink with bupropion. This is because going through alcohol withdrawal syndrome while on bupropion can reduce the threshold for seizures and also cause adverse effects such as:
- Severe shaking and tremors
- Confusion or disorientation
People are advised to talk to a healthcare provider before quitting alcohol while on bupropion. It’s also recommended that they refrain from any social drinking while on antidepressants such as bupropion.
Bupropion and Alcohol – The Risk of Overdose
The liver can only process a limited amount of a substance at one time. So when alcohol and bupropion are combined, it will be conditioned to only process small quantities of each substance. This slow processing time will result in increased side effects of both the alcoholic drink and bupropion. It can also increase the amount of alcohol that ends up in the bloodstream and heighten the risk of alcohol poisoning or overdose. Overdoses are a medical emergency. So it’s important to seek immediate medical attention when one faces the following symptoms:
- Irregular breathing (a gap of more than 10 seconds in between breaths)
- Slow breathing (less than eight breaths per minute)
- Pale skin
- Low body temperature
Other Risks of Combining Bupropion with Alcohol
In addition to the risk of overdose and seizures, combining alcohol with bupropion can also increase the risk of severe side effects. The combination can enhance each other’s effects and cause:
- Dizzy spells
- Blurred vision
- Digestive distress
- Dry mouth
The combination can also increase the risk of suicidal thoughts and behaviors associated with bupropion. Bupropion comes with a black box warning to alert people and physicians of its possibility to cause suicidal thoughts and behaviors in children, teens, and young adults. Combining it with alcohol can further increase the risk and make it difficult for people to carry out their normal lives.
Individuals combining alcohol with bupropion to attain a chemical high are at risk of developing an alcohol use disorder and an addiction to bupropion. The physical dependence on alcohol or/and bupropion is a serious problem that can cause adverse, long-term health complications.
The combination of any two substances is dangerous, not just bupropion and alcohol. People should be extremely cautious in using any substance and refrain from combining it with other substances in order to lead a healthier, fulfilling life.
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