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Health Guide / Drugs

Buspar and alcohol: risks and side effects

steve silvestro

Reviewed by Steve Silvestro, MD, written by Ashley Braun, RD, MPH

Last updated: Jul 08, 2021
5 min read

table of contents

  1. What is Buspar?
  2. Side effects of buspirone
  3. Buspar drug interactions
  4. Effects of alcohol on anxiety
  5. Dangers of mixing Buspar with alcohol
  6. Buspar and alcohol withdrawal

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Many people drink alcohol as a way to unwind at the end of a long day. It’s so common that you may not realize alcohol is actually a drug. It acts as a depressant to the central nervous system (CNS), which includes the brain and spinal cord—hence, it’s sometimes called a “downer.” Alcohol can even interact with other medications, especially ones that affect the CNS. 

This article discusses the anti-anxiety medication Buspar and its interaction with alcohol. Buspar and alcohol don’t mix well together. Let’s take a look at why.

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What is Buspar?

Buspar is the brand name of the prescription drug buspirone (see Important Safety Information). Buspar was discontinued in the U.S., but it is still available under the generic name buspirone. It’s a type of anti-anxiety medication, also called an anxiolytic, used to treat anxiety.

Buspirone has effects on serotonin and dopamine receptors in the brain. These neurotransmitters are known to play a role in anxiety. By impacting the brain’s regulation of serotonin and dopamine, buspirone helps relieve symptoms of anxiety. 

The Food and Drug Administration (FDA) approves buspirone to treat generalized anxiety disorders (Wilson, 2020). 

Buspirone can also be used “off-label” for treating other conditions. Off-label use means the FDA didn’t explicitly approve it for that use. Still, healthcare providers can prescribe drugs for unapproved use if they determine it’s the right treatment option for their patients.

Off-label uses of buspirone include (Wilson, 2020):

Side effects of buspirone

While Buspirone may work wonders for your anxiety symptoms, it can cause some side effects. The most common side effect of buspirone is dizziness. 

Rare side effects of buspirone include (Wilson, 2020):

  • Abnormal dreams
  • Drowsiness
  • Ataxia (loss of coordination or muscle control)
  • Confusion, lightheadedness, nervousness, and outbursts of anger or excitement
  • Headache
  • Numbness, muscle pain, tremor, or weakness
  • Diarrhea and nausea
  • Sore throat and nasal congestion
  • Skin rash
  • Chest pain

Some of these symptoms may only be present during the beginning of treatment and resolve over time. Research suggests you can minimize side effects by increasing the dose of buspirone slowly (Wilson, 2020).

Rarely, people taking buspirone may experience akathisia or serotonin syndrome. Akathisia is a rare side effect of antidepressant medications that leads to a state of agitation, trouble sitting still, and restlessness. Serotonin syndrome occurs in people taking more than one medication that affects the neurotransmitter serotonin, leading to excessive amounts of serotonin in the blood. Some of the symptoms include high blood pressure, stiff muscles, rapid heart rate, confusion, agitation, and restlessness. If you experience any of these symptoms, please seek medical attention right away. 

Buspar drug interactions

Other prescription medications may alter the effectiveness of buspirone when taken together. They can also lead to adverse effects. So, buspirone shouldn’t be taken (Wilson, 2020):

  • Within 14 days of taking a monoamine oxidase inhibitor (MAOI) because, together, these could cause high blood pressure or serotonin syndrome
  • With other sedatives because they could increase the risk for side effects
  • With opioids because this could increase the risk for respiratory distress, sedation, and coma
  • With other anti-anxiety medications because this could compound the side effects
  • With grapefruit juice because it affects liver enzymes and increases the effectiveness of the medications, leading to a higher risk for side effects

Effects of alcohol on anxiety

Alcohol is classified as a depressant and a sedative. It slows down the nervous system’s activity, which means you may feel a temporary relief from anxiety symptoms. However, you may build up a tolerance to alcohol, meaning you would need to have more alcohol to feel the same effects.

Research shows that anxiety disorders and alcohol abuse commonly occur together. Long-term alcohol use may worsen anxiety symptoms (Gorka, 2017). Not to mention, excessive alcohol use may lead to addiction and withdrawal symptoms, as well as other negative effects on your health and social life.  

Dangers of mixing Buspar with alcohol

Alcohol and buspirone both produce similar effects on the central nervous system. They can make you feel tired, light-headed, nauseous, and dizzy. 

Because of those overlapping effects, you shouldn’t take buspirone with sedatives or alcohol. Drinking alcohol while taking buspirone can increase the effects of both and cause more severe side effects, such as (Wilson, 2020):

  • Slowed breathing or difficulty breathing
  • Problems controlling muscles
  • Increased risk for falls and injury
  • Unusual behaviors
  • Memory problems or short term memory loss

These side effects are dangerous and can be life-threatening. If you’re experiencing any of these symptoms after combining alcohol with buspirone, seek immediate medical attention. 

Buspar and alcohol withdrawal

The FDA doesn’t approve buspirone for helping to manage alcohol withdrawal. Still, there is some research to suggest this as an off-label use for buspirone. Older research suggests buspirone could help reduce withdrawal symptoms (Dougherty, 1990). One small study showed it reduces alcohol cravings by 40% (Bruno, 1989). 

We don’t fully understand the relationship between Buspar and alcohol withdrawal, and recent research is limited on this topic.

Some research suggests gamma-aminobutyric acid (GABA) is the primary neurotransmitter affected by alcohol. GABA’s normal effect is to inhibit or depress certain parts of the nervous system. Chronic alcohol exposure enhances GABA receptors, producing increased depressant effects on the brain (Newman, 2021). 

A class of medication called benzodiazepines affects the receptors for GABA. This type of medication, not buspirone, is typically recommended to prevent alcohol withdrawal symptoms. Both chlordiazepoxide and oxazepam are benzodiazepines commonly used to treat alcohol withdrawal (Newman, 2021). Other examples of benzodiazepines include alprazolam (Xanax) and diazepam (Valium).

The symptoms of alcohol withdrawal can be serious, and you shouldn’t try to manage them on your own. You can usually manage mild symptoms at home with the support of your healthcare provider.

People with moderate to severe alcohol withdrawal symptoms or people without social support at home will likely be admitted to the hospital for inpatient treatment. Symptoms of alcohol withdrawal can include (Newman, 2021):

  • Nausea and vomiting
  • Headache
  • Visual or auditory (hearing) hallucinations
  • Sweating
  • Agitation
  • Headache
  • Abnormal electrolytes
  • Tremor or shaking
  • Anxiety
  • Trouble concentrating
  • Confusion
  • Seizures

If you or someone you know struggles with a mental health problem or substance abuse, contact the Substance Abuse and Mental Health Services Administration’s National Helpline at 1-800-622-4357. This helpline offers free, confidential, 24/7 support for treatment referrals and informational services for individuals and their families struggling with these problems.

References

  1. Bruno, F. (1989). Buspirone in the treatment of alcoholic patients. Psychopathology, 22 Suppl 1, 49–59. doi: 10.1159/000284626. Retrieved from https://pubmed.ncbi.nlm.nih.gov/2657838/
  2. Gorka, S. M. & Phan, K. L. (2017). Impact of anxiety symptoms and problematic alcohol use on error-related brain activity. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 118, 32–39. doi: 10.1016/j.ijpsycho.2017.05.011. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546210/
  3. Newman, R. K., Stobart Gallagher, M. A., & Gomez, A. E. (2021). Alcohol withdrawal. [Updated May 29, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441882/
  4. Wilson, T. K. & Tripp, J. (2020). Buspirone. [Updated Aug 12, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK531477/
  5. Zia, S. (2013). Placental location and pregnancy outcome. Journal of the Turkish German Gynecological Association, 14(4), 190–193. doi: 10.5152/jtgga.2013.92609. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/074054729090021H
steve silvestro
Steve Silvestro, MD

Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.

Related articles

Important Safety Information for Buspirone

What is the FDA-approved use of buspirone?

Buspirone is used for the management of generalized anxiety disorder or the short-term relief of the symptoms of anxiety.

Who should not use buspirone?

Do not use buspirone if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), the antibiotic linezolid (Zyvox), or intravenous methylene blue. If you take buspirone at the same time as an MAOI, there is an increased risk of serotonin syndrome and high blood pressure.
  • You have a known allergic reaction to buspirone.

How should I take buspirone?

You can take buspirone with or without food. 

You should take buspirone exactly as prescribed, and continue to take buspirone as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking buspirone without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using buspirone?

  • Buspirone has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
    • Benzodiazepines, such as diazepam (Valium)
    • SSRIs or SNRIs, such as sertraline (Zoloft)
    • Migraine medications called triptans, such as sumatriptan (Imitrex)
    • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Depression
    • Suicidal thoughts or attempted suicide
    • Bipolar Disorder
    • Family history of Bipolar Disorder or family history of suicide
    • Liver problems
    • Kidney problems
    • Parkinson’s Disease
    • High blood pressure
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. You should discuss with your provider if buspirone should be used during pregnancy and while breastfeeding.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking buspirone?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with buspirone. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of a drug that increases the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Cognitive and Motor Impairment: Buspirone may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. You should avoid alcohol while taking buspirone.
  • Neurologic effects: There have been rare reports of impaired neurologic function with use of buspirone. Symptoms may resemble symptoms of Parkinson’s Disease, such as restlessness, repetitive movements, inability to sit still, and involuntary movements (tardive dyskinesia). Tell your provider if you are experiencing these symptoms.

What are the most common side effects of buspirone?

  • Dizziness
  • Nausea
  • Headache
  • Nervousness
  • Lightheadedness
  • Excitement, jitteriness

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information. 

Important Safety Information for Sertraline

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted. 

What is the FDA-approved use of sertraline?

Sertraline is a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of Major Depressive Disorder (MDD).

Who should not use sertraline?

Do not use sertraline if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You are taking a medication called pimozide. Taking this medication with sertraline can increase the risk of prolonged QT interval, which is a potentially dangerous change to the electrical signals that make your heart beat.
  • You have a known allergic reaction to sertraline.

How should I take sertraline?

You can take sertraline with or without food. 

You should take sertraline exactly as prescribed, and continue to take sertraline as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking sertraline without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using sertraline?

  • Sertraline has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
    • NSAIDs, such as ibuprofen or naproxen
    • Aspirin
    • Blood thinners, such as warfarin (Coumadin)
    • Migraine medications called triptans, such as sumatriptan (Imitrex)
    • Other SSRIs or SNRIs, such as fluoxetine (Prozac)
    • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Suicidal thoughts or attempted suicide
    • Bipolar Disorder
    • Family history of Bipolar Disorder or family history of suicide
    • Liver problems
    • Irregular heartbeat or heart problems
    • Stroke
    • High blood pressure
    • Seizures
    • Glaucoma or eye problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if sertraline should be used during pregnancy or while breastfeeding.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking sertraline?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with sertraline. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when sertraline is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Increased risk of bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Sertraline may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, or blood thinners such as warfarin (Coumadin).
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • QT Prolongation: Tell your provider right away if you experience fast, slow, or irregular heart rate, shortness of breath, fainting, or dizziness, which may indicate serious cardiac arrhythmia.
  • Cognitive and Motor Impairment: Fluoxetine may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while you take sertraline.

What are the most common side effects of sertraline?

  • Nausea, loss of appetite, diarrhea, or indigestion
  • Increased sweating
  • Tremor or shaking
  • Agitation
  • Change in sleep habits including increased sleepiness or insomnia
  • Sexual problems including abnormal ejaculation, erectile dysfunction, or decreased sex drive
  • Feeling tired or fatigued
  • Anxiety

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.