Can you drink alcohol on Mysimba?
Mysimba combines bupropion and naltrexone — two substances that each have their own interaction with alcohol. Below, per drinking pattern, what the risk is and what our BIG-registered doctors advise.
Short answer
On the maintenance dose, most people can tolerate one standard glass of alcohol with a meal. In the first 4 weeks (titration), alcohol is strongly discouraged altogether. Binge drinking (>4 units) is dangerous because of the increased risk of seizures via bupropion. Daily heavy drinking is a contraindication and a reason to stop Mysimba.
Risk per drinking pattern
In the Netherlands, one standard glass is 10 g of alcohol — e.g. 250 ml beer (5%), 100 ml wine (12%), or 35 ml spirits (35%).
| Scenario | Frequency | Risk | Explanation |
|---|---|---|---|
| First 4 weeks of Mysimba (titration) | Any alcohol | High | During the titration phase your body has to get used to bupropion and naltrexone at the same time. Alcohol intensifies dizziness and nausea and can trigger seizures (bupropion lowers the seizure threshold). Our doctors advise staying completely dry during these 4 weeks. |
| Maintenance phase, social drink (≤1 unit) | 1 glass of wine / beer per week | Low | One standard glass on a social occasion is tolerated by most people on the maintenance dose. The risk of significant side effects is low, but never drink on an empty stomach. |
| Maintenance phase, moderate (2-3 units in one evening) | 1× per week or less | Moderate | Possible effects: extra headache the next morning, nausea, sleep disturbances. Naltrexone can dampen the 'rewarding' feeling of alcohol — you may drink less than before, or feel less of a buzz. |
| Binge drinking (>4 units in 2 hours) | One-off | High | Combining bupropion with a large alcohol spike strongly increases the risk of convulsions (seizure). Also a risk of acute hypoglycaemia and cardiac arrhythmias. Do not do it. |
| Daily heavy drinking (>3 units/day) | Daily | Avoid | Absolute contraindication. Bupropion combined with chronic alcohol use gives a sharply increased risk of epilepsy, liver damage and dependency problems. Your doctor will not prescribe Mysimba, or will stop it immediately. |
| Stopping suddenly after chronic drinking | Withdrawal | Avoid | Heavy drinkers who stop suddenly experience withdrawal symptoms that can cause seizures in themselves. Mysimba increases this risk. Always stop under medical supervision — not alone. |
Why is alcohol an issue with Mysimba?
Four mechanisms explain why the advice differs from, say, paracetamol or an ordinary vitamin.
Bupropion lowers the seizure threshold
Bupropion is an antidepressant that, besides weight loss, is also prescribed for depression and smoking cessation. A known effect — described in every patient leaflet — is a slightly increased risk of seizures, especially at high doses, with abrupt alcohol withdrawal or in combination with large amounts of alcohol. In Mysimba, the bupropion dose (90 mg per tablet, 4 tablets/day on maintenance) is deliberately kept moderate, but the warning still stands.
Naltrexone dampens the 'rewarding' effect of alcohol
Naltrexone is an opioid antagonist that blocks the reward pathway in the brain. It is also prescribed on its own to people with alcohol dependence — precisely because it reduces the buzz and the 'pleasant' feeling of drinking. For Mysimba users this means alcohol often tastes less good or gives less relaxation. Some spontaneously drink less as a result; others drink more to get the same effect — that second pattern is dangerous.
Alcohol worsens gastrointestinal side effects
Mysimba itself already frequently causes nausea, dry mouth, and constipation or diarrhoea. Alcohol worsens all of these complaints. In the first weeks — when gastrointestinal side effects are at their highest — drinking alcohol is a recipe for a bad evening and poor adherence.
Combination with other medication
Many people who use Mysimba also take antidepressants, sleeping pills, blood pressure medication or painkillers. Alcohol intensifies the side effects of almost all of these, and bupropion raises the blood levels of some antidepressants via CYP2D6 inhibition. Always ask your doctor which interactions are relevant for your medication list.
Seek immediate medical help for
- A seizure after alcohol + Mysimba
- Loss of consciousness or confusion
- Persistent vomiting (longer than 8 hours)
- Sharp abdominal pain on the right or in the middle (pancreas / liver)
- Yellowing of the skin or whites of the eyes (jaundice)
Call 112 or the out-of-hours GP service (huisartsenpost). Always mention that you take Mysimba and how much you have drunk.
Frequently asked questions
Doubts about Mysimba or the alcohol interaction?
Our BIG-registered doctors review your situation personally and advise whether Mysimba suits you.
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