Lybalvi interactions: Alcohol, medications, and other factors

Before you start treatment with Lybalvi, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Lybalvi interacts with supplements, herbs, or vitamins, see the “Lybalvi and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Lybalvi. Keep in mind that this table doesn’t include all drugs that may interact with Lybalvi. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* Lybalvi should not be taken with these drugs. See “When to avoid Lybalvi” just below for more information.
† To learn more about this interaction, see the “Drug interactions in depth” section below.
‡ For details about Lybalvi’s side effects, you can explore this article.

In some cases, factors or conditions could prevent your doctor from prescribing Lybalvi due to the risk of harm. These are known as contraindications. The contraindications of Lybalvi include:

Taking opioids

Doctors typically will not prescribe Lybalvi in combination with opioids. Opioids are strong pain relievers that your body can become physically dependent on. Some opioids are used to treat opioid use disorder.

Taking Lybalvi with an opioid can block the effect of the opioid, making it ineffective in relieving pain. If you’re physically dependent on opioids, taking Lybalvi can cause opioid withdrawal symptoms. These are side effects that can occur when you stop taking an opioid that your body has become dependent on. Withdrawal symptoms can be severe enough to need treatment in a hospital.

Below are a few examples of opioids that can interact with Lybalvi:

• methadone (Methadose)
• morphine (MS Contin)
• oxycodone (OxyContin, others)
• tramadol (ConZip)

Before you start treatment with Lybalvi, it’s important to tell your doctor if you take opioids. They’ll likely prescribe a treatment other than Lybalvi. Or they may wait for at least 1–2 weeks after you stop taking opioids before prescribing Lybalvi.

Going through opioid withdrawal

Doctors typically will not prescribe Lybalvi for people who have recently stopped taking opioids and have opioid withdrawal symptoms. That’s because Lybalvi can make opioid withdrawal symptoms worse.

Before you start treatment with Lybalvi, it’s important to tell your doctor if you’ve recently stopped taking opioids. Your doctor may prescribe a treatment other than Lybalvi. Or they may wait until you’ve been free from opioids for at least 1–2 weeks (depending on the opioid) before prescribing Lybalvi.

Note: Before you start treatment with Lybalvi, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Lybalvi.

If you drink alcohol, your doctor will likely recommend that you do not drink it while taking Lybalvi.

Consuming alcohol and taking Lybalvi may cause serious side effects, including:

• sleepiness
• dizziness
• orthostatic hypotension

Alcohol can also worsen the condition you’re taking Lybalvi to treat. For example, if you have bipolar disorder, alcohol consumption may worsen your symptoms.

If you have concerns about avoiding alcohol while you’re taking Lybalvi, talk with your doctor before starting treatment.

Here’s a closer look at certain drug interactions of Lybalvi.

Blood pressure medications

Lybalvi can interact with medications prescribed for high blood pressure.

Interaction result: Taking Lybalvi with blood pressure medications can cause low blood pressure and orthostatic hypotension.

Interaction explained: Lybalvi can cause orthostatic hypotension in some people. If you take Lybalvi with medications that lower your blood pressure, you may have a higher risk of this side effect. To learn about Lybalvi’s side effects, see this article.

Examples of blood pressure medications: Here are some blood pressure medications that may interact with Lybalvi:

• atenolol (Tenormin)
• doxazosin (Cardura)
• losartan (Cozaar)
• ramipril (Altace)

Steps you or your doctor may take: If you take Lybalvi with a blood pressure medication, keep in mind that your blood pressure may drop when you change position. To help avoid this, try to move slowly when you get up or change position. This can allow your blood pressure to adjust. If you feel dizzy or lightheaded, it’s best to sit or lie down until these symptoms pass.

If you feel dizzy or have episodes of orthostatic hypotension while taking Lybalvi with a blood pressure medication, talk with your doctor. They may adjust your dosage of the blood pressure medication.

Anticholinergics

Lybalvi can interact with medications in the anticholinergic drug class. Doctors prescribe them for several different conditions. These include overactive bladder, chronic obstructive pulmonary disease (COPD), Parkinson’s disease, and other movement disorders. Other medications can have anticholinergic activity too. Examples include some antidepressants, antipsychotics, and antihistamines.

Interaction result: Taking Lybalvi with drugs that have anticholinergic activity can raise your risk of anticholinergic side effects. These include dry mouth, blurry vision, difficulty urinating, confusion, and severe constipation.

Interaction explained: Lybalvi has some anticholinergic activity. Taking it with other drugs that have anticholinergic activity can raise your risk of anticholinergic side effects.

Examples of anticholinergic drugs: Here are some anticholinergics that may interact with Lybalvi:

• benztropine (Cogentin)
• glycopyrrolate (Robinul, others)
• orphenadrine
• oxybutynin (Oxytrol)

Steps you or your doctor may take: If you take Lybalvi with an anticholinergic drug, tell your doctor if you have anticholinergic side effects, especially constipation. Your doctor may adjust your dosage of the anticholinergic drug.

Benzodiazepines

Lybalvi can interact with benzodiazepines, which are prescribed to reduce anxiety and aid sleep.

Interaction result: Taking Lybalvi with benzodiazepines can raise your risk of sleepiness and orthostatic hypotension.

Interaction explained: Lybalvi and benzodiazepines can both cause sleepiness and orthostatic hypotension as a side effect. So taking these drugs together can raise your risk of these side effects.

Examples of benzodiazepine drugs: Here are some benzodiazepines that may interact with Lybalvi:

• alprazolam (Xanax)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (Ativan)

Steps you or your doctor may take: If you take Lybalvi with a benzodiazepine, your blood pressure may go down when you change position. To help your blood pressure adjust, take care when you change position and move slowly. If you feel dizzy or lightheaded, sit or lie down until these symptoms subside.

If you have bothersome sleepiness, dizziness, or orthostatic hypotension while taking Lybalvi with a benzodiazepine, talk with your doctor. They may adjust your dosage of either medication. Or they may recommend switching to a different medication.

Lybalvi may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Lybalvi.

Lybalvi interactions with supplements

Before you start treatment with Lybalvi, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Lybalvi interactions with herbs

Doctors will typically recommend you avoid taking St. John’s wort with Lybalvi. St. John’s wort is an herbal supplement that may be used to treat depression and other conditions.

St. John’s wort may speed up the activity of an enzyme in your body called cytochrome P450 3A4 (CYP3A4). This enzyme helps break down Lybalvi.

By speeding up this enzyme, St. John’s wort can cause Lybalvi to break down more quickly. And this may lead to a low level of Lybalvi in your system. If the level of Lybalvi in your system is too low, the drug may not work to treat your condition.

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Lybalvi interactions with vitamins

There are no specific reports of vitamins interacting with Lybalvi. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Lybalvi.

Lybalvi and food

There were no reports of food interactions with Lybalvi. If you’d like to learn more about eating certain foods during treatment with Lybalvi, talk with your doctor.

Lybalvi and vaccines

There aren’t any known interactions between Lybalvi and vaccines. Talk with your doctor or pharmacist to check whether you’re due for any vaccines.

Lybalvi interactions with lab tests

Lybalvi may interfere with the results of certain lab tests. Taking the medication may cause a false-positive result on a urine drug screening test that checks for the presence of opioids. This means the test could show that you have opioids in your urine even if you do not. Such urine tests may be required by an employer or for other reasons.

Because of this, it’s important to tell the person giving you the test that you’re taking Lybalvi.

For additional information, talk with your doctor or pharmacist.

LYBALVI INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with olanzapine (Zyprexa). (Olanzapine is one of the active drugs in Lybalvi.) Taking cannabis or cannabis products with Lybalvi can increase your risk of sleepiness.

Before you start treatment with Lybalvi, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many U.S. states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Lybalvi. Before you take this drug, be sure to talk with your doctor about your health history. Lybalvi may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Lybalvi include:

• Allergic reaction: If you’ve had an allergic reaction to Lybalvi or any of its ingredients, your doctor will likely not prescribe Lybalvi. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Diabetes: Lybalvi can increase your blood sugar levels. If you have diabetes, this can make your blood sugar harder to manage. Talk with your doctor about whether Lybalvi is right for you.
• High cholesterol or triglycerides: If you have high cholesterol or triglyceride levels, taking Lybalvi could raise them more. Your doctor may check your cholesterol and triglyceride levels more often while you’re taking Lybalvi.
• Low blood pressure: Lybalvi can make your blood pressure fall when you stand up, which can cause dizziness or fainting. If you have low blood pressure, you may have an increased risk of this side effect with Lybalvi. Talk with your doctor about whether Lybalvi is right for you.
• Heart disease or past heart attack or stroke: If you have heart disease or you’ve had a past heart attack or stroke, taking Lybalvi could raise your risk of heart attack or stroke. Talk with your doctor about whether Lybalvi is right for you.
• Low white blood cell count: Lybalvi can lower your white blood cell count. If you currently have or have had a low white blood cell count, tell your doctor. This includes a low white blood cell count caused by a medication. Your doctor will likely monitor your white blood cell level while you’re taking Lybalvi.
• Trouble swallowing: If you have difficulty swallowing, Lybalvi could make this worse. Talk with your doctor about whether Lybalvi is the right treatment option for you.
• History of seizures: Lybalvi can cause seizures in some people. If you have a history of seizures, you may have an increased risk of this side effect. Your doctor will advise you about whether Lybalvi is safe for you.
• Difficulty urinating: Lybalvi can sometimes cause difficulty urinating. If you have trouble urinating or you have a history of urinary retention, tell your doctor. They’ll determine whether Lybalvi is appropriate for you.
• Constipation: Lybalvi can sometimes cause constipation. Be sure to tell your doctor if you have constipation or you’ve had past digestive problems, such as paralytic ileus. They can advise whether Lybalvi is right for you.
• High prolactin levels: Lybalvi can increase levels of the hormone prolactin. If you already have high prolactin levels, talk with your doctor about whether Lybalvi is right for you.
• Breast cancer: High prolactin levels can encourage some breast cancers to grow. Lybalvi can increase prolactin levels. If you’ve ever had breast cancer, ask your doctor about whether Lybalvi is safe for you.
• History of opioid misuse: If you have a history of opioid misuse, talk with your doctor about whether Lybalvi is right for you. Lybalvi blocks the effects of opioids. Trying to overcome this by taking large amounts of opioids can cause a fatal opioid overdose. Your doctor may not prescribe Lybalvi if there’s a risk you could take opioids during or soon after your treatment. They can recommend other treatment options. To learn more about Lybalvi and opioids, see the “When to avoid Lybalvi” section above.
• Smoking: Smoking tobacco makes your body get rid of Lybalvi faster than usual, which can make the drug less effective. Before starting Lybalvi, tell your doctor if you smoke. And while taking Lybalvi, talk with your doctor if you plan to quit smoking. Your doctor may need to adjust your Lybalvi dosage.
• Hot temperatures or strenuous exercise: Lybalvi can make it harder for your body to keep cool in hot temperatures and when exercising heavily. It’s important to drink plenty of fluids in these situations. For more information about this side effect, talk with your doctor or pharmacist.
• Planned surgery: If you’re due to have surgery, talk with your doctor beforehand about your Lybalvi treatment. Lybalvi can block the effects of opioid pain relievers that your doctor may prescribe during or after surgery. A few days before your surgery, your doctor may have you switch to a different medication that doesn’t block opioids.
• Breastfeeding: It’s not known whether it’s safe to take Lybalvi while breastfeeding. Olanzapine (one of the active drugs in Lybalvi) passes into breast milk and may cause side effects in a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before starting Lybalvi. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: There haven’t been enough clinical trials to determine whether Lybalvi is safe to take while pregnant. However, taking olanzapine during the last trimester of pregnancy can cause side effects in a newborn. If you’re pregnant or planning to become pregnant, tell your doctor before starting Lybalvi. They can advise you on the right treatment plan for you.
• Kidney problems: Your kidneys help clear Lybalvi from your body. If you have a kidney problem, Lybalvi could build up in your body. This could raise your risk of side effects.* So your doctor may prescribe a dosage of Lybalvi that’s lower than usual.†

* For details about Lybalvi’s side effects, see this article.
† To learn about Lybalvi and dosage, see this article.

You can take certain steps to help prevent interactions with Lybalvi. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol, smoke, or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Lybalvi label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Lybalvi doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Lybalvi by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Lybalvi. These resources might help:

• Overview of Lybalvi: For a general overview of Lybalvi, you can see this article.
• Side effects: If you’re interested in the side effects of Lybalvi, see this article. Another option is to refer to the Lybalvi prescribing information.
• Dosage specifics: To learn about the dosage of Lybalvi, see this article.
• Facts about your condition: To learn more about the conditions Lybalvi is prescribed to treat, see our bipolar disorder hub and list of schizophrenia articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.