5 Drinks to Avoid Mixing With Antipsychotics if You Have Schizophrenia

Managing schizophrenia involves a combination of strategies, and antipsychotic medication is a key piece of the puzzle. There are some important things to keep in mind while on antipsychotics. For starters, it’s crucial to take them consistently to avoid relapse, says Ashvin Sood, MD, an attending psychiatrist at Washington Interventional Psychiatry in Washington, DC.

It’s also important to know how your daily habits might affect your medication. Even the everyday beverages you drink, for example, could negatively interact with antipsychotic medications or worsen certain side effects. It’s a good idea to talk with your doctor about potential drug interactions and substances you should avoid while taking antipsychotics, says Taren Coley, MD, a psychiatrist and director of child and adolescent services at HopeWay, in Charlotte, North Carolina.

Here are five drinks experts suggest limiting or avoiding when taking antipsychotics for schizophrenia.

Drinking alcohol while taking antipsychotics can sometimes lead to drowsiness or sedation. The risk is higher with certain medications with sedating side effects, according to Ozan Toy, MD, MPH, chief medical officer at PsychTMS, a mental health care clinic in Towson, Maryland. Examples include older, first-generation antipsychotics like haloperidol, as well as newer, second-generation ones such as olanzapine or quetiapine.

Be mindful of consuming caffeinated drinks like coffee, tea, and soda when taking antipsychotic medication. Caffeine is a stimulant, which means its energizing effects can sometimes counteract the calming or sedating effects of antipsychotics.

Furthermore, caffeine is processed through the liver, which may interfere with the metabolism of the antipsychotic medications themselves, says Toy.

“One important enzyme in the liver, called CYP1A2, is involved in metabolizing [breaking down] both caffeine and certain antipsychotics (most famously clozapine and olanzapine, which are atypical antipsychotics),” says Sood. “Essentially, caffeine can slow down the breakdown of those antipsychotics. Morning coffee might inhibit the CYP1A2 enzyme a bit, meaning your body isn’t breaking down the medication as fast, leading to complications such as an unintentional overdose.”

In other words, if you take antipsychotics like clozapine or olanzapine, for example, consuming caffeine could unintentionally boost the medication levels in your system and increase the risk of side effects or overdose.

Despite these potential interactions, caffeine isn’t entirely bad if you’re taking antipsychotics. The most important step is to talk openly with your doctor about how much caffeine you typically consume to ensure it’s a safe amount, especially if you’re taking clozapine or olanzapine, Sood says.

It’s not uncommon to see “avoid grapefruit” warnings on medication labels.

This is true for some antipsychotics, too.

The reason: “Grapefruit juice contains compounds that can interfere with the metabolism of some antipsychotics, leading to higher-than-intended medication levels in the bloodstream,” says Dr. Coley. “This can increase the risk of side effects, such as excessive sedation, dizziness, or other adverse reactions,” she says. For this reason, Coley generally recommends avoiding grapefruit juice altogether when taking these medications.

The core issue involves how your body processes the medication. Grapefruit juice contains compounds that block a key enzyme, CYP3A4, found in the intestine and liver, says Sood. Several antipsychotics, especially many of atypical antipsychotics, are metabolized by this enzyme, says Sood.

“For example, quetiapine (Seroquel), lurasidone (Latuda), and ziprasidone (Geodon) are all at least partly broken down by CYP3A4. If you drink grapefruit juice while on these meds, you could experience a spike in the medication’s level,” Sood adds. “Even one glass (about 200 milliliters) of grapefruit juice can cause a noticeable increase in drug levels for certain medications, and the effect can last for a day or more.”

Certain herbs commonly found in teas may also interact with antipsychotic medications.

Many of these teas are marketed as “natural”, but “natural” doesn’t automatically mean “safe” alongside prescription medications, says Toy.

Echinacea tea, for example, may have sedative effects and could lead to oversedation when combined with medications that already cause drowsiness, Toy notes. Similarly, teas marketed for relaxation that contain valerian root, passionflower, or chamomile also require caution. These can enhance the sedative effects of certain antipsychotics and contribute to feelings of confusion and drowsiness, says Tony M. Issac, MD, an addiction psychiatrist at Raritan Bay Medical Center in Perth Amboy, New Jersey.

“Kava, a herbal remedy that has been associated with multiple uses, including anxiety, has also been associated with liver toxicity, which is concerning given that numerous psychiatric medications are metabolized through the liver,” Dr. Issac adds. Even green tea, while often considered healthy, contains compounds (catechins) that can interfere with absorption of certain medications such as clozapine, he notes.

Given these varied potential interactions, Issac stresses the importance of telling your doctor about any herbs you’re consuming, including herbal teas.

Energy drinks are generally not recommended for individuals taking antipsychotic medication due to their high caffeine content and stimulant properties, says Issac. Some evidence suggests the stimulant effects of these drinks can worsen schizophrenia symptoms like anxiety, agitation, or paranoia.

“Many energy drinks contain taurine and other additives that can influence neurotransmitter activity, potentially leading to an unpredictable impact on psychiatric medications,” says Issac.

Another concern is the high sugar content found in many energy drinks. This can contribute to weight gain and metabolic problems — side effects already associated with many second-generation antipsychotics, Issac adds.

The extreme caffeine levels in some energy drinks can also lead to insomnia, rapid heartbeat, and elevated blood pressure.

“If the antipsychotic is controlling psychosis, but you flood yourself with stimulants, one might experience heightened anxiety or even chest pain from the palpitations,” says Sood.

Need a simple, safe choice? You can always rely on water. It keeps you hydrated without interfering with your antipsychotic medication or adding any of the risks mentioned above. Milk and fruit juices are also safe, healthy options for people with schizophrenia.

If you’ve been prescribed antipsychotics, be sure to discuss your consumption of alcohol, caffeine, grapefruit juice, energy drinks, and any herbal products with your doctor to understand how they might interact with your antipsychotic medications.
Remember that herbal beverages or those marketed as “natural” aren’t automatically safe for people taking antipsychotics, as they may still lead to drug interactions.
Pay close attention to any new or worsening side effects and contact your doctor if you suspect a potential interaction.

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