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Seroquel and Alcohol: The Dangers of Quetiapine Interactions

Last Updated: March 20, 2025

Authored by Dr. Ahmed Zayed

Reviewed by Michael Espelin APRN

Medically Reviewed 0 sources cited

Seroquel interactions occur when substances interfere with the medication’s effects on brain neurotransmitters or liver metabolism. The medication experiences three primary interaction types: drug interactions with medications like antidepressants and blood pressure drugs causing drowsiness or irregular heart rhythms; disease interactions with conditions like heart disease and diabetes requiring dosage adjustments; and alcohol/food interactions, particularly with grapefruit affecting blood levels and alcohol enhancing sedative effects. 

Alcohol combined with Seroquel presents significant dangers, contributing to drunk-driving deaths. Understanding these interactions proves essential for safe medication use and preventing harmful side effects.

Seroquel (Quetiapine) is an antipsychotic medication used to treat mental health conditions such as schizophrenia, bipolar disorder, and depression. Seroquel interacts with 739 other drugs, including 147 major interactions, 588 moderate interactions, and 4 minor interactions, according to the article published in 2018 by Lakshmi N Yatham, titled “Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD)”. 

Seroquel interacts with various medications, leading to significant adverse effects. Blood pressure medications increase orthostatic hypotension risk, while CNS depressants enhance sedation and impair function. QT-prolonging drugs cause cardiac arrhythmias, and anticholinergics worsen constipation and urinary retention. CYP3A4 inhibitors raise Seroquel levels, while St. John’s Wort reduces its concentration. NSAIDs increase bleeding and kidney risks, and diabetes medications lose effectiveness due to hyperglycemia. Warfarin requires INR monitoring, and serotonergic drugs heighten serotonin syndrome risk. Tricyclic antidepressants intensify sedation and cardiac issues. Regular monitoring and consultation with healthcare providers are crucial for patients on these combinations.

The risks of Seroquel interactions include severe sedation with antidepressants, dangerous respiratory depression with alcohol, increased toxicity from grapefruit consumption, worsening of heart conditions and diabetes, fatal overdose potential, intense withdrawal effects, and tissue damage from misuse through snorting.

Table of Contents:

What are Seroquel Interactions?

Seroquel interactions are reactions that occur when this medication affects or is affected by other substances, leading to changes in its effectiveness or increased side effects. These interactions occur because Seroquel works by influencing brain neurotransmitters like dopamine and serotonin, and is metabolized by specific liver enzymes. When substances such as other medications, alcohol, or certain foods interfere with these processes, they decrease Seroquel’s effectiveness, intensify its effects beyond intended levels, or cause dangerous side effects. Understanding these interactions is essential for the safe use of Seroquel and to prevent potential health complications.

How Many Types of Seroquel Interactions Are There?

There are 3 main types of Seroquel interactions including drug interactions, food interactions, and alcohol interactions. Drug interactions occur when Seroquel is taken with other medications such as antidepressants, sedatives, or blood pressure drugs, which leads to excessive drowsiness, irregular heart rhythms, or dangerously low blood pressure.

Food interactions with grapefruit and grapefruit juice affect how the liver processes Seroquel, which increases the Seroquel levels in the bloodstream and increases the risk of side effects. Alcohol interactions are life-threatening, as drinking alcohol while on Seroquel increases drowsiness, dizziness, and cognitive impairment, which makes activities such as driving dangerous.

There were 13,524 deaths in the United States in 2022 due to drunk-driving crashes, accounting for about 32% of all traffic fatalities, according to the statistics taken from the National Highway Traffic Safety Administration. It is important to understand these interactions to ensure Seroquel is used safely and therapeutically.

Here is a chart explaining Seroquel interactions with medications, diseases, and alcohol or food:

The 3 types of Seroquel interactions are listed below.

1. Drug interactions. Seroquel interacts with various medications, including antidepressants, sedatives, blood pressure drugs, and certain antibiotics by either increasing side effects or altering drug therapeutics. These interactions increase side effects such as drowsiness, dizziness, and irregular heart rhythms or reduce the effectiveness of either medication.
2. Disease interactions. Seroquel interacts with pre-existing health conditions such as heart disease, diabetes, seizures, and liver disorders by either worsening symptoms or changing how the body processes the medication. People with these conditions require special monitoring or dosage adjustments to prevent complications.
3. Alcohol/food interactions. Seroquel interacts with alcohol and certain foods such as grapefruit by altering how it is absorbed and metabolized in the body Alcohol enhances Seroquel’s sedative effects, which increases the risk of extreme drowsiness and impaired thinking, while grapefruit increases Seroquel levels in the bloodstream, which leads to to to more severe side effects.

How Does Alcohol Affect Seroquel?

Alcohol affects Seroquel by enhancing Seroquel’s ability to depress the central nervous system when taken together, which leads to extreme drowsiness, dizziness, and a higher risk of accidents, including falls and accidents. Alcohol and Seroquel should not be combined because both substances have sedative effects that impair brain function and bodily coordination. Combining alcohol with sedative medications such as Seroquel increases sedation by up to 50%, which makes everyday activities, such as walking or operating machinery, highly dangerous, according to a study published by the National Institute on Alcohol Abuse and Alcoholism.

Long-term use of alcohol while taking Seroquel worsens mental health symptoms, reduces the medication’s effectiveness, and increases the chances of liver damage. Chronic alcohol consumption also increases the risk of severe side effects, including respiratory depression, irregular heart rhythms, and cognitive decline. Excessive alcohol intake with Seroquel has been linked to overdose and life-threatening complications in some cases. Individuals taking Seroquel should completely avoid alcohol or consult their doctor if consumption is considered to avoid these dangers.

What Are The Medications That Interact with Seroquel?

The medications that interact with Seroquel include blood pressure medications, CNS depressants, and anticholinergic drugs which lead to increased side effects or reduced therapeutics.

The 10 medications that interact with Seroquel are briefly discussed below.

• Blood pressure medications. Taking Seroquel with antihypertensive drugs enhances the risk of orthostatic hypotension, a sudden drop in blood pressure upon standing, which results in dizziness or fainting. This occurs because both Seroquel and blood pressure medications lower blood pressure. Examples include lisinopril and metoprolol. Patients should be cautious when standing up and report any episodes of dizziness to their healthcare provider, according to the article published on Healthline.
• Central Nervous System (CNS) depressants. Medications such as benzodiazepines (e.g., alprazolam, diazepam) and opioids (e.g., oxycodone, hydrocodone) increase Seroquel’s sedative effects, which leads to drowsiness, respiratory depression, and impaired motor function. This combination impairs cognitive and motor abilities, which increases the risk of accidents. Patients should avoid operating heavy machinery or driving when using these medications.
• Drugs that prolong the QT interval. Combining Seroquel with medications that extend the QT interval increases the risk of life-threatening heart arrhythmias. Examples include certain antibiotics such as azithromycin and antiarrhythmic drugs such as amiodarone. Both Seroquel and these medications prolong the QT interval, and their combined effect leads to serious cardiac events. Monitoring heart function through electrocardiograms (ECGs) is recommended when these drugs are used together.
• Anticholinergic drugs. Using Seroquel alongside anticholinergic medications (e.g., oxybutynin, tiotropium) causes side effects such as constipation and urinary retention due to additive anticholinergic properties. This combination leads to severe gastrointestinal issues and discomfort. Patients should inform their healthcare provider if they experience major changes in bowel or bladder habits, according to the article published on Healthline.
• Enzyme inhibitors and inducers. Drugs that inhibit CYP3A4 (e.g., ketoconazole, ritonavir) raise Seroquel levels, which increases side effect risks. CYP3A4 inducers (e.g., phenytoin, carbamazepine) lower Seroquel concentrations, which reduces its therapeutic efficacy. Adjustments in Seroquel dosage are necessary when these medications are introduced or discontinued. Regular monitoring of Seroquel levels and clinical response is important in these situations.
• St. John’s Wort. St. John’s Wort is a herbal supplement that decreases Seroquel levels in the body and reduces its effectiveness. St. John’s Wort induces the CYP3A4 enzyme, which leads to increased metabolism of Seroquel. Patients should inform their healthcare provider of any herbal supplements they are taking to ensure proper management of their medications, according to the study published in 2021 by Monica W Harbell, titled “Antipsychotic-associated weight gain: management strategies and impact on treatment adherence.”
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Taking NSAIDs such as ibuprofen and naproxen with Seroquel increases the risk of gastrointestinal bleeding and kidney damage, especially in older adults. NSAIDs also reduce kidney function, which leads to fluid retention, which causes blood pressure fluctuations. Patients should consult their doctor before using NSAIDs frequently if they have pre-existing kidney or cardiovascular conditions.
• Diabetes medications. Seroquel has been linked to increased blood sugar levels and a higher risk of developing diabetes. There is a risk of uncontrolled blood sugar fluctuations when taken with metformin, insulin, or sulfonylureas (e.g., glipizide, glyburide), Seroquel-induced hyperglycemia makes diabetes medications less effective, which requires dose adjustments. Regular monitoring of blood glucose levels is important for patients on both medications.
• Warfarin and blood thinners. Seroquel interacts with warfarin (Coumadin) and other anticoagulants, which affects blood clotting ability. This combination increases the risk of excessive bleeding or blood clot formation if Seroquel alters liver enzymes responsible for breaking down warfarin. Patients on blood thinners should undergo regular INR (International Normalized Ratio) testing to monitor their clotting function.
• Serotonergic medications (SSRIs, SNRIs, and tricyclic antidepressants). Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline, as well as serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, increase serotonin levels when combined with Seroquel. This raises the risk of serotonin syndrome, a serious condition causing agitation, rapid heart rate, fever, and muscle stiffness. Tricyclic antidepressants (e.g., amitriptyline, nortriptyline) also increase sedation and heart rhythm complications when taken with Seroquel. Patients experiencing mood changes, muscle twitching, or confusion should seek medical attention.

What Are The Risks Of Seroquel Interactions?

The risks of Seroquel interactions include medication conflicts with antidepressants and sedatives, dangerous alcohol combinations leading to extreme drowsiness, food interactions particularly with grapefruit, worsening of existing medical conditions, potentially fatal overdose possibilities, significant withdrawal symptoms, and serious misuse dangers.

Here are the risks of Seroquel interactions in detail below:

• Drug Interactions: Seroquel interacts with medications like antidepressants, sedatives, and blood pressure drugs, increasing risks of sedation, respiratory depression, and irregular heart rhythms. Combining with QT-prolonging drugs (e.g., azithromycin) raises arrhythmia risks, while CYP3A4 inhibitors (e.g., ketoconazole) elevate Seroquel levels, worsening side effects. Serotonergic drugs (e.g., SSRIs) heighten serotonin syndrome risk, and anticholinergics exacerbate constipation and urinary retention.
• Alcohol Interactions: Alcohol intensifies Seroquel’s sedative effects, causing extreme drowsiness, impaired coordination, and overdose risk. Chronic use worsens mental health symptoms and liver damage.
• Food Interactions: Grapefruit inhibits Seroquel metabolism, increasing bloodstream levels and toxicity risks. High-fat meals delay absorption but do not significantly alter effects.
• Disease Interactions: Seroquel worsens conditions like heart disease (orthostatic hypotension), diabetes (hyperglycemia), seizures, and liver disorders. Monitoring and dosage adjustments are required for these patients.
• Overdose Risks: Lethal doses often involve combinations with alcohol/opioids, exceeding 3,000 mg. Symptoms include respiratory depression, seizures, and cardiac arrhythmias. According to Lee, J.’s 2018 study, ‘Increasing rates of quetiapine overdose, misuse, and mortality in Victoria, Australia’, quetiapine overdose rates increased dramatically in Victoria, Australia from 2006 to 2016. The research documented a 6-fold increase in quetiapine-related calls to the Victorian Poisons Information Centre during this period, with 77% of these calls relating to overdose incidents. Quetiapine-related deaths increased 7.4-fold over the same timeframe.
• Withdrawal Symptoms: Abrupt discontinuation causes nausea, insomnia, agitation, and psychiatric rebound (anxiety, psychosis). Tapering under medical supervision is advised.
• Misuse Dangers: Snorting Seroquel damages nasal tissue, bypasses slow-release mechanisms, and increases overdose risks (respiratory depression, heart issues). According to Dobravc Verbič, M.’s 2024 study, ‘Acute Quetiapine Intoxication: Relationship Between Ingested Dose, Serum Concentration and Clinical Presentation—Structured Literature Review and Analysis’, higher quetiapine doses and serum concentrations correlate directly with increased risk of severe clinical outcomes, specifically predicting the need for intubation, development of tachycardia, the occurrence of hypotension, prolongation of QTc intervals, and onset of seizures in quetiapine intoxication. The typical half-life in quetiapine intoxication extends to 16.5 hours, substantially exceeding the duration observed at therapeutic doses. Central nervous system depression and tachycardia emerge as the predominant clinical manifestations in quetiapine intoxication cases.

How to Minimize Seroquel Interactions?

To minimize Seroquel interactions, it is important to take several precautions. Inform your healthcare provider about all prescription medications, over-the-counter drugs, herbal supplements, and vitamins you are using. This allows your doctor to assess potential interactions and adjust your treatment plan accordingly.

Avoid consuming grapefruit or grapefruit juice, as it inhibits the enzyme CYP3A4, responsible for metabolizing Seroquel, which leads to increased drug levels in the bloodstream and a higher risk of side effects. Alcohol consumption should be limited or avoided, as it enhances Seroquel’s sedative effects, increasing the risk of drowsiness and dizziness.

It is also important to be cautious when using other central nervous system (CNS) depressants, such as benzodiazepines or opioids, as they increase sedation and respiratory depression when combined with Seroquel.

Patients should also be aware of medications that prolong the QT interval, such as certain antibiotics such as azithromycin, and antiarrhythmic drugs such as amiodarone, as combining them with Seroquel increases the risk of life-threatening heart arrhythmias. Regular communication with a healthcare provider and routine check-ups are required for monitoring Seroquel’s effects and adjusting dosages if necessary.

Is Seroquel Considered a Controlled Substance?

No, Seroquel (quetiapine) is not classified as a controlled substance under the U.S. Controlled Substances Act. Seroquel is a prescription-only medication that should be used under medical supervision.

What is a Lethal Dose of Seroquel?

The lethal dose of quetiapine (Seroquel) varies but fatal cases typically show blood levels of 10-25 mg/L.

According to Šoša, I.’s 2024 study, ‘Quetiapine-Related Deaths: In Search of a Surrogate Endpoint.’, blood samples from fatal quetiapine cases contain concentrations of 10-25 mg/L during postmortem examinations. Non-toxic postmortem blood levels extend to 0.8 mg/kg while toxic levels begin at 0.35 mg/kg. Quetiapine overdose survivors showed serum or plasma concentrations ranging from 1 to 10 mg/L. Quetiapine toxicity rarely causes death alone and typically requires combination with other drugs to be fatal. Deaths linked to quetiapine involve cardiac effects through inhibition of hERG channels affecting the QT interval. Cardiovascular pathologies present additional risk factors when quetiapine is used, particularly in polydrug intoxications.

What Are The Withdrawal Symptoms of Seroquel?

Common withdrawal symptoms of Seroquel include nausea, vomiting, insomnia, dizziness, headaches, irritability, agitation, and flu-like symptoms. Stopping Seroquel abruptly leads to withdrawal symptoms, especially in individuals who have taken it for an extended period. In severe cases, withdrawal causes a return or worsening of psychiatric symptoms such as anxiety, depression, or psychosis. It is recommended that Seroquel withdrawal be tapered off gradually under medical supervision.

What are the Dangers of Snorting Seroquel?

The dangers of snorting Seroquel are severe respiratory issues, nasal damage, and an increased risk of overdose. Seroquel bypasses its intended slow-release mechanism when inhaled and causes rapid absorption, extreme sedation, respiratory depression, and heart problems. Misuse of Seroquel increases the chances of dependence and serious side effects, including hallucinations and seizures.

Can Seroquel be Taken with Other Medications?

No, Seroquel should not be taken with other medications because the reactions have possible negative consequences. Seroquel interacts with many different medications including antidepressants, blood pressure drugs, sedatives, and antibiotics. Some combinations increase the risk of drowsiness, low blood pressure, or irregular heart rhythms. It is essential to consult a doctor before combining Seroquel with any other medications to avoid harmful interactions.

Can I Take Over-the-Counter Painkillers with Seroquel?

Yes, you can take over-the-counter painkillers with Seroquel, but with caution. Common pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are generally considered safe in moderate doses. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen increase the risk of gastrointestinal issues. Stronger pain medications, opioids, should only be taken under medical supervision due to their potential for dangerous sedation and respiratory depression when combined with Seroquel.

Is Caffeine Safe with Seroquel?

Yes, caffeine is safe with Seroquel however, caffeine reduces the sedative effects of Seroquel, especially for those taking it for sleep or anxiety. High caffeine intake also worsens side effects such as jitteriness, restlessness, or heart palpitations. It is advisable to consume caffeine in moderation while on Seroquel.

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