Alcohol and Anticonvulsants: Drinking on Seizure, Migraine, or Mood Meds

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Convulsions, or seizures, are caused by abnormal electrical activity in the brain. Medication, including anticonvulsants, may be used to reduce the number and severity of seizures, as well as to treat conditions like epilepsy.¹ With all medications, there are risks, and anticonvulsants are no different. For example, if you mix anti-seizure medication like Keppra and alcohol, you could experience symptoms like dizziness, brain fog, and extreme sedation.²

What Are Anticonvulsants?

The primary purpose of anticonvulsant medication is to prevent or reverse the abnormal electrical activity that causes a seizure.

Off-label prescribing is both legal and common. According to the Agency for Healthcare Research and Quality, 1 in 5 prescriptions are written for off-label use. ³

Common off-label uses for anticonvulsants include:⁴

• Migraine relief
• Anxiety reduction
• Mood stabilization
• Neuropathic pain relief
• Parkinson’s disease treatment
• Alcohol withdrawal

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Benzodiazepines are a common type of anticonvulsant that may control seizures. However, levetiracetam, fosphenytoin, and valproate, which are three medicines are also commonly prescribed, especially for severe seizure disorders.⁵

How Does Alcohol Interact With Anticonvulsants?

Mixing substances like Lamictal and alcohol, or Keppra and alcohol, may lead to a negative interaction. Symptoms of interaction often include dizziness, drowsiness, and changes in mental health. For some, the mixture can increase the risk for seizures.⁶

Alcohol increases the effects of anticonvulsant medication, including:²

• Somnolence, or excessive sleepiness
• Mood swings
• Headaches
• Memory loss
• Confusion
• Increased blood pressure
• Gastrointestinal problems
• Hypersensitivity reactions
• Paresthesia
• Depression
• Aggression
• Respiratory depression

What Are the Side Effects of Alcohol and Anticonvulsants?

When you mix anticonvulsants like Keppra and alcohol, the potential risks associated with the medication and with alcohol intoxication increase and worsen. Risks associated with anticonvulsants include the following:⁷

• Blood disorders
• Inflammation in the lining of the brain
• Swelling in tissues
• Dry mouth
• Digestive complications
• Pain anywhere on the body
• Dizziness, drowsiness
• Organ sensitivity

Lamictal, which is frequently used off-label as a mood stabilizer, is also associated with a condition characterized by a rash that appears at the start of treatment that can require hospitalization. It is unknown if the combination of Lamictal and alcohol increases the occurrence of this rash.

Some anticonvulsants produce adverse psychiatric behavioral reactions, such as:⁸

• Agitation
• Hostility
• Depression
• Psychosis, or a complete disconnection with reality
• Suicidal ideation

Alcohol misuse leads to harmful effects on the brain and body, which overlap with anticonvulsants. Examples include:⁹

• Cirrhosis, or progressive liver disease
• Kidney disease
• Cardiovascular, or heart, disease
• Respiratory problems
• Certain mental health symptoms, including depression and anxiety
• Potential seizure activity, especially during with withdrawal for individuals with previous history of seizure

What Are the Risks of Alcohol and Anticonvulsants?

When taking anticonvulsants in large doses, an overdose can potentially occur. When mixed with alcohol, the potential for an overdose increases.

Signs of overdose involving anticonvulsants such as Lamictal, Topamax, gabapentin, Keppra and alcohol include the following:¹⁰

• Extreme drowsiness
• Loss of consciousness
• Respiratory depression
• Slowed heart rate
• Possible coma

Anticonvulsants are not typically associated with dependence and addiction. However, when mixed with alcohol, the combination may lead to one or both. If your body is dependent, you experience withdrawal symptoms when you stop misusing alcohol and medication.

Withdrawal symptoms may include nausea, vomiting, shaking, cravings, mood swings, and more. Dependence may be characterized by continuing to using a combination of alcohol and medication specifically to avoid withdrawal symptoms.¹¹ Doing so increases your chances of becoming addicted.

Addiction to alcohol mixed with medications can happen. If you find yourself spending increasing amounts of time mixing alcohol and anticonvulsants, feeling unable to reduce or stop use, and continuing to use the combination despite known negative effects, this could indicate the need for a polysubstance misuse and addiction screening.¹²

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How Should You Respond to a Negative Reaction?

While you may not notice significant symptoms in some situations, but if you notice signs of an overdose, call 911. If possible, provide the medications that were mixed with alcohol and describe symptoms occurring. Not all situations require emergency help; follow the directions of the operator.

Medically significant symptoms include:¹³

• Skin rashes of any size, color, or reaction
• Swelling in the face, eyes, lips
• Unusual bruising or bleeding
• Increased anxiety, depression, or suicidal ideation
• Headache
• Fever
• Nausea or vomiting
• Sensitivity to light
• Unusual mood changes
• Severe pain anywhere on the body

Can You Drink Alcohol While on Anticonvulsants?

In some cases, your doctor may be able to create a plan that allows a specific number of alcoholic drinks that do not interfere with your anticonvulsant medication.

Anticonvulsants like Keppra and alcohol can lead to alcohol-induced seizures.

Alcohol misuse may also lead to forgetting if you’ve taken your medication and, therefore, taking more or less than prescribed. You may also experience metabolic imbalances or sleep disturbances.¹⁴

How Do You Manage Alcohol Addiction While Taking Anticonvulsants?

Epilepsy is not the only condition for which anticonvulsants are prescribed. It’s essential to understand how drinking alcohol can affect these other conditions for which you are taking anti-seizure medicine and then learn how to manage both. Below are some recommendations.

Psychotherapies

Psychotherapies are counseling techniques used by licensed therapists trained to help you manage co-occurring disorders, such as having an alcohol use disorder and taking an anticonvulsant for bipolar disorder. These therapies include:¹⁵

• Cognitive-behavioral therapy focuses on changing unhealthy thought patterns that influence behaviors such as mixing Keppra and alcohol.
• Motivational enhancement therapy encourages those not ready to enter recovery find personal motivation to change behavior.
• Dialectical behavioral therapy is a form of cognitive-behavioral therapy that teaches emotional regulation.
• Contingency management is a therapeutic tool that rewards you for meeting goals while in treatment.
• Family-focused therapy helps the ones you love who have been affected by your alcohol misuse.
• 12-step facilitation groups provide structure and sponsor support in completing specific steps that support long-term recovery.

Co-Occurring Integrated Treatment

If you have two or more disorders, simultaneous treatment improves recovery outcomes. Co-occurring treatment starts with an individualized treatment plan and includes the following:¹⁶

• Medication-assisted therapy (MAT)
• Behavioral therapies
• Peer-lead support groups, such as Alcoholics Anonymous
• Online support groups
• Building recovery capital
• Multi-system family therapies
• Psychoeducation, including on how mixing anticonvulsants like Keppra and alcohol affects your body and mind

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When looking for a treatment program, it’s best to choose one with appropriate staff who can address co-occurring conditions, such as a seizure disorder and alcohol addiction. Your top choice may be a treatment facility with a psychiatrist, psychologist, general physician, nurses, therapists, and technicians.¹⁷

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Resources

1. U.S. National Library of Medicine. (2022, February 18). Seizures. MedlinePlus.
2. Kumar, A., Maini, K., & Kadian, R. Levetiracetam. (2021, June 20). Treasure Island (F.L.): StatPearls Publishing.
3. Agency for Healthcare Research and Quality. (2015). Off-Label Drugs: What You Need to Know.
4. Subbarao, B.S., Silverman, A., & Eapen, B.C. (2021, July 13). Seizure Medications. Treasure Island (F.L.): StatPearls Publishing.
5. National Institute of Health. (2019, December 10). Drugs Equally Effective for Severe Seizure Disorder.
6. National Institute of Alcohol Abuse and Alcoholism. (2014). Harmful Interactions: Mixing Alcohol with Medicines.
7. Betchel, N.T., Fariba, K.A., & Saadabadi, A. (2022, February 21). Lamotrigine. Treasure Island (F.L.): StatPearls Publishing.
8. Ogunsakin, O., Tumenta, T., Louis-Jean, S., Mahbub, A., Rabel, P., Olupona, T., & Alam, S. (2020). Levetiracetam Induced Behavioral Abnormalities in a Patient with Seizure Disorder: A Diagnostic Challenge. Case Reports in Psychiatry, 2020, 8883802.
9. Iranpour, A. & Nakhaee, N. (2019). A Review of Alcohol-Related Harms: A Recent Update. Addiction & Health, 11(2), 129–137.
10. U.S. National Library of Medicine. (2021, June 15). Levetiracetam. MedlinePlus.
11. U.S. National Library of Medicine. (2022, February 18). Alcohol Withdrawal. MedlinePlus.
12. U.S. National Library of Medicine. (2022, February 18). Alcohol Use Disorder. MedlinePlus.
13. Center for Disease Control and Prevention. (2020, September 30). Epilepsy.
14. U.S. Food and Drug Administration. (2015). Lamictal.
15. Hamerle, M., Ghaeni, L., Kowski, A., Weissinger, F., & Holtkamp, M. (2018). Alcohol Use and Alcohol-Related Seizures in Patients with Epilepsy. Frontiers in Neurology, 9, 401.
16. Farren, C. K., Hill, K. P., & Weiss, R. D. (2013, December 01). Bipolar Disorder and Alcohol Use Disorder: A review. Current Psychiatry Reports, 14(6), 659–666.
17. Yule, A.M. & Kelly, J.F. (2019, October 24). Integrating Treatment for Co-Occurring Mental Health Conditions. Alcohol Research Current Reviews, 40(1).