bupropion + alcohol withdrawal

[hi strung]

OK SO. Just started on Wellbutrin SR to combat shitty side effects of Zoloft. Prescribed 150mg twice a day. I know there can be issues combining it (like most other crazy pills) with booze. I did something stupid by drinking a lot the first few days I took it.

I am not a heavy daily drinker, but I am known to occasionally binge drink on weekends. For whatever reason, the drinking of this weekend spanned Thursday, Friday and Saturday night. (And I know alcohol + SSRI isn't necessarily a great idea, but I've adjusted to the change in tolerance and 3 of my good friends are Zoloft takers and drinkers, so...we're stubborn 24 year olds after all.)

What has me worried is the possibility of alcohol withdrawal-induced seizures in people taking WB. The first night I took it, I had 3 beers, second night 4-5 glasses of wine, third night (last night) 4 pints of beer and maybe 2 shots worth of vodka. Augh I feel like a dumbass. What should I do in this situation, since I have been giving myself increasingly large doses of ethanol? Temporarily stop taking the WB? I wish I hadn't taken it this morning.

I've done some googling and know I can expect to feel fairly shitty for a while. Should I alert those around me to the possibility I might seize?? Eek! Please don't tell me how dumb that was...I know. But any advice/experience would be helpful.

[AirMarshall]

Do you have any history of seizures or reason to think you have an increased susceptibility?

-Disregarding any seizures, if you want to feel really lousy start messing with your med dosages too...

I really don't want to tell you to keep drinking so you can begin a good taper!

Alcohol clears the body at about 1oz. per hour. So, assuming you aren't drinking around the clock, if you were drinking in the evening you should already be clean.

Since you are concerned it makes sense to call your doctor and ask the expert! If it makes you more comfortable, ask your roomates or family to keep an eye on you. Can't hurt anyway with med changes.

Be good, hope you feel better soon. a.m.

[justme04]

ugh i hear you there zoloft has such crappy side effects, and i got put on welbutrition for the same reason...

if you're concerned about side effects or seizures while on it, i would suggest calling your doctor and asking him/her about it, he or she will best be able to tell you

[hi strung]

I am pretty sure that part of my panic was due to the increased anxiety that I get from the WB a few hours after I take it. I feel less worried about impending seizures...might call a pharmacist because I'm too sheepish to tell my doc what a boozehound was this weekend. Boyfriend has been warned and told what to do if I start flopping around. Fingers crossed.

Thanks dudes.

And no, no history of seizures in me or my family, that I know of.

[hi strung]

I did fuck up! Granted, so did my family practice nurse practitioner. Time to get an actual psychiatrist.

I am pretty sure I had a simple partial seizure (aka aura with no bigger subsequent seizure) last night. Numb, prickly legs; pulsing, vibrating drone in my ears (what you would imagine a hovering UFO would sound like); depersonalization. Subsequent scary doomed feeling and headache that is still not gone. Nothing bigger though.

Here's what I think happened:

1. Things lowering seizure threshold, such as the WB, the Zoloft, binge drinking, sleep deprivation (WB insomnia), lower blood sugar (WB anorexia).

2. Overloading my liver on booze making the other stuff stick around my system longer.

3. Drug interactions my NP failed to mention (mostly inhibited clearance of various due to them all needed the CYP450 2D6 isoenzyme).

4. Taking 2 a day rather than starting with 1 at the outset (again, thanks NP).

Also I didn't realize this but my mom seized on WB and Adderall when I was a kid. Not sure which type, but she had auras and then passed out at a truck stop. I had no idea that was why until I called her last night! She's also been various levels of dependent on prescription opiates so she may of had some inhibited liver function.

I was all scared, anticipating a possible worse seizure, so did not sleep much at all. Feel crappy. Wah. Don't do what I did!

[olga]

Thanks for letting us know what happened.

I take the XL300 version, and the instructions on the bottle clearly state "Do not drink alcohol while taking this medicine."

I haven't run into problems with a single glass of wine, but everyone is different. I agree that you ought to be seeing a pdoc for your psych meds.

olga

[null0trooper]

I was all scared, anticipating a possible worse seizure, so did not sleep much at all. Feel crappy. Wah. Don't do what I did!

Lack of sleep ALSO lowers the seizure threshold

However, if the same thing starts happening again, you will want to talk to a doctor about switching to a different AD. This is one symptom (set of them really) that will not just go away if you ignore it. And, don't do what I did - go straight from Wellbutrin to Cymbalta with only a one week taper to 150 mg (my liver really hated me that first day)

As far as drinking goes, I had a wierd side-effect from Wellbutrin: I could not stand to taste or smell alcohol while I was on it, so I never had to bother with drinking only in moderation.

[crtclms]

While I am not discounting that it is a seizure, I just wanted to point out that all those symptoms and sensations could be migraine auras, and you said yourself that you have a persistent headache. My husband does have migraines after seizures, but it is very rare. A handful in the 11 years I have known him, and he seizes pretty much weekly. Of course, I am sure some people with epilepsy often have post-ictal headaches, I am just saying you need to talk to your p-doc before assuming you had a seizure.

And the fact that your mother had a seizure on a combo of Wellbutrin and adderal doesn't necessarily mean that you have a genetic predisposition for having seizures on Wellbutrin, either: Wellbutrin and adderal are pretty much contraindicated except in rare circumstances, precisely because combining them creates a severe risk of seizures. It was a questionable combo for her to be on. The adderal probably played a significant part in her seizure.

Again, I am not saying it wasn't a seizure, I am just saying none of your symptoms preclude a different diagnosis.

[mcjimjam]

Are you certain it was a seizure? I have panic attacks that feel just like what you describe. I had a lot more of them on WB because it's so stimulating.

[null0trooper]

Wellbutrin and adderal are pretty much contraindicated except in rare circumstances, precisely because combining them creates a severe risk of seizures. It was a questionable combo for her to be on. The adderal probably played a significant part in her seizure.

The primary interaction risk between bupropion and amphetamine is that one is a catecholamine reuptake inhibitor and the other stimulates catecholamine release - potentially very synergistic. Whether the worry is about amplifying the stimulant's cardiovascular effects, or the possibility of some noradrenaline syndrome analogous to serotonin syndrome, isn't entirely clear and I don't have a PDR handy.

Personally, I was on that combination for some time because Adderall was one of the few things that actually moderated the side-effects of Wellbutrin for me, including some of the olfactory hallucinations I was having and didn't think enough about to tell my doctor (Yes, I know, I should have identified what was going on months before first partial seizure hit. Perfect, I ain't)

[crtclms]

You may not have noticed, but I actually specifically said, "except in rare circumstances." I included that caveat for a reason. I am completely aware there are always exceptions. That is why I used a qualifier. I also have taken contraindicated medications at the same time, as have many people on CBs.

My point is, her mother's having had a seizure on that particular combination of meds does not necessarily indicate that the OP has a genetic propensity for seizures. The whole point of the contraindication is that it is a huge seizure risk. We aren't even sure the OP has had a seizure in the first place. She shouldn't assume she can't use it because of that particular piece of familial background.

Maybe I misinterpreted, but she said she is concerned about the interactions between the two substances, and did not indicate that she is going to stop binge drinking. Even if the sensations she felt the next day were from the interaction of alcohol and Wellbutrin, that doesn't automatically mean she should give up on the Wellbutrin. Maybe it means she shouldn't binge drink while on a psychiatric med.

We also don't know if binge drinking itself might have caused symptoms.

Of course she should call her p-doc immediately, but until then, she can't actually be certain what happened to her.

As I already said, I am not discounting the possibility of its being a seizure. I am just pointing out that all her symptoms might also indicate migraine, or other conditions as well. So she should also consider that possibility, and wait before she throws Wellbutrin overboard until she talks to her doctor.

[SashaSue]

Hi strung, have you spoken to your doctor yet?

[hi strung]

Hi dudes.

So, as you can imagine, I've done a shit-ton of research after that went down. I'm not assuming that it was seizure activity for sure, but it would definitely be believable I think due to the massive amount of alcohol and starting at 300mg instead of titrating up to it.

I've come to the conclusion that it's equally likely, symptom wise, that it was seizure activity, migraine, panic attacks, or plain and simple side effects. I know it is technically possible to have migraines with only moderate headache, so maybe that!

The night after that happened, I woke up at 2:30 am with my ears ringing loudly, and assumed the worst (of course), that something seizurey was happening again. Thus, I panicked and began having a bunch of other symptoms (cold prickly rushes to hands and feet, dizziness, feelings of major dread and fear, crying). That, I've determined, was probably a panic attack, instigated by my alarm at the ears ringing. I've since discovered that ringing in the ears on WB is pretty common, and I only notice it at night when trying to sleep. Since then I haven't panicked or felt alarmingly weird at all.

I've also started taking only 150mg per day until I can see a pdoc. (Splitting and taking 75mg morning and evening.) I know I shouldn't really mess around with the meds on my own, but I don't trust my NP and I also don't want to be taken off the WB prematurely bc it's already helping with the stuff that indicated its prescription (sexual side effects). That said, the general SEs are annoying (fuzzy feeling and tenseness), but I expect it to settle down.

Here's what I'm doing now: MORNING- 25mg Z, 75mg WB, 10mg propanolol; EVENING- 75mg WB, 10mg propanolol. Anybody see anything wrong with that? It seems very moderate to me. I'd like to take the lowest dose of WB that can help me orgasm.

[hi strung]

Hi strung, have you spoken to your doctor yet?

Nope, I am bad. I am avoiding my nurse practitioner and waiting to have a psych intake done so I can get a real pdoc.

[hi strung]

Maybe I misinterpreted, but she said she is concerned about the interactions between the two substances, and did not indicate that she is going to stop binge drinking. Even if the sensations she felt the next day were from the interaction of alcohol and Wellbutrin, that doesn't automatically mean she should give up on the Wellbutrin. Maybe it means she shouldn't binge drink while on a psychiatric med.

I am planning on stopping with the binge drinking. I see it as a good excuse for something that's not healthy even without the added variable of psych meds. We'll see how successful I am with this, as most of my close friends are party animals, but I think it will be ok. Just an adjustment.

[SashaSue]

Hi strung, have you spoken to your doctor yet?

Nope, I am bad. I am avoiding my nurse practitioner and waiting to have a psych intake done so I can get a real pdoc.

You really need to call your np. Seizures are kind of a big deal. Messing with your meds is kind of a big deal.

And actually, if it's really seizures you've got going on, you'll need to see a neurologist. So you might as well go see your NP and get that referral going.

[SashaSue]

Maybe I misinterpreted, but she said she is concerned about the interactions between the two substances, and did not indicate that she is going to stop binge drinking. Even if the sensations she felt the next day were from the interaction of alcohol and Wellbutrin, that doesn't automatically mean she should give up on the Wellbutrin. Maybe it means she shouldn't binge drink while on a psychiatric med.

I am planning on stopping with the binge drinking. I see it as a good excuse for something that's not healthy even without the added variable of psych meds. We'll see how successful I am with this, as most of my close friends are party animals, but I think it will be ok. Just an adjustment.

Planning on stopping? You realize that sounds pretty lame, right?

Honestly, if you're going to continue this kind of binge drinking, there's not much point in seeing a pdoc and trying to figure out meds. Binge drinking makes a lot of crazy people crazier. So, if you're dissatisfied with your current crazy level, have at it!

[hi strung]

Planning on stopping? You realize that sounds pretty lame, right?

Honestly, if you're going to continue this kind of binge drinking, there's not much point in seeing a pdoc and trying to figure out meds. Binge drinking makes a lot of crazy people crazier. So, if you're dissatisfied with your current crazy level, have at it!

I think you misunderstood. That weekend was the last episode, and I have no plan to do it again. So, I guess it would be more accurate to say that I've stopped. I just didn't want to jump the gun and proclaim my success in case my willpower doesn't measure up. That and I don't think my pals would let me drink a ton, and I'm not one to drink alone or with anonymous bar pals, so.

[SashaSue]

Planning on stopping? You realize that sounds pretty lame, right?

Honestly, if you're going to continue this kind of binge drinking, there's not much point in seeing a pdoc and trying to figure out meds. Binge drinking makes a lot of crazy people crazier. So, if you're dissatisfied with your current crazy level, have at it!

I think you misunderstood. That weekend was the last episode, and I have no plan to do it again. So, I guess it would be more accurate to say that I've stopped. I just didn't want to jump the gun and proclaim my success in case my willpower doesn't measure up. That and I don't think my pals would let me drink a ton, and I'm not one to drink alone or with anonymous bar pals, so.

Oh good! I'm so glad to hear I'd misunderstood that. .