Zyban and Alcohol

  I have been taking Zyyban (buproprion) for the past two weeks.  This past weekend I went to a club with friends.  I had two or three mild drinks before leaving my friends house.  It was a good thing I was not driving...I am afraid the alcohol and Zyban do not mix.  I ended up blacking out and not remembering anything I did that night.  My friends told me I appeared highly intoxicated, which after two drinks I am not.  My boyfriend told me that my breath smelled "sickeningly fruity sweet" a sign of ketoacidosis, true?  Is this a normal side effect of Zyban and alcohol.  If so I must know so as to warn my friends who also take the drug.  It has done wonders for my cravings and withdrawl (withdrawal) symptoms, but the incident this weekend scared the crude out of me.  Please help.

[SA, M.D. - HVMA]

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Dear Jennifer,
I haven't heard such a clear description of this type of adverse reaction involving bupropion and alcohol.  However, I am not surprised by it.  I routinely advise people who are able to drink (in other words, they are not alcoholics, pregnant, or have a medical condition or treatment which precludes drinking) to drink sparingly when taking any psychoactive medication such as bupropion (Zyban).  What does it mean to drink sparingly?  2-4 standard drinks per week for women and men over 65, never exceeding 1 standard drink at a sitting OR 3-6 standard drinks per week for men under 65 and never more than 2 at a sitting.
Another reason not to drink much while taking bupropion is that the combination of bupropion and alcohol may increase the risk of seizures, which is the most serious (although relatively infrequent) adverse effect associated with bupropion.
As smokers are at increased risk of developing alcohol problems, you should be careful with alcohol even after you finish with the bupropion.
For more information about smoking cessation and drinking, check out my Ask DrSteve web site, conveniently hyperlinked below.  Good luck staying away from tobacco!
Steve Adelman, M.D. (a.k.a. DrSteve)
This information is for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Ask DrSteve:  The Real Story About Smoking, Drinking & Getting High

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