Lybalvi (olanzapine/samidorphan) is a prescription drug used to treat bipolar I disorder and schizophrenia. This drug can interact with alcohol, other medications, and some supplements. For example, Lybalvi can interact with opioids and diphenhydramine (Benadryl).
Lybalvi is used in adults to treat bipolar I disorder and schizophrenia.
Lybalvi contains two active ingredients: olanzapine and samidorphan. It’s available in oral tablets.
An interaction can occur when one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Lybalvi’s possible interactions. And for more information about Lybalvi, including details about its uses, see this article.
Before you start taking Lybalvi, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Lybalvi interacts with herbs or vitamins and supplements, see the “Are there other interactions with Lybalvi?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Lybalvi. Keep in mind that this table does not include all drugs that may interact with Lybalvi. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| benzodiazepines | • diazepam (Valium) • alprazolam (Xanax, Xanax XR) • lorazepam (Ativan, Loreev XR) | can increase the risk of side effects from Lybalvi and benzodiazepines |
| opioids | • buprenorphine (Brixadi, Sublocade, others) • hydrocodone (Hysingla ER) • oxycodone (OxyContin, Xtampza ER, others) | can increase the risk of opioid withdrawal (Learn more about this interaction in the “When should I avoid Lybalvi?” section below.) |
| blood pressure drugs | • atenolol (Tenormin) • doxazosin (Cardura, Cardura XL) • spironolactone (Aldactone, Carospir) | can increase the effect of blood pressure drugs |
| certain antihistamines | • cetirizine (Zyrtec, Quzyttir) • diphenhydramine (Benadryl) • meclizine (Antivert, Bonine, others) | can increase the risk of sleepiness from Lybalvi and certain antihistamines |
| certain antibiotics | • ciprofloxacin (Cipro) • clarithromycin • rifampin (Rifadin, Rimactane) | can make Lybalvi less effective or increase the risk of side effects from Lybalvi and certain antibiotics |
| certain seizure drugs | • carbamazepine (Carbatrol, Tegretol, others) • phenytoin (Dilantin, Phenytek) • phenobarbital (Sezaby) | can make Lybalvi less effective |
| certain antifungals | • fluconazole (Diflucan) • ketoconazole • itraconazole (Sporanox, Tolsura) | can increase the risk of heart rhythm problems from Lybalvi and certain antifungals |
| certain Parkinson’s disease drugs | • levodopa (Inbrija) • carbidopa/levodopa (Rytary, Sinemet, others) • bromocriptine (Parlodel) | can make Lybalvi and certain Parkinson’s disease drugs less effective |
| bupropion (Aplenzin, Wellbutrin XL, others) | — | can increase the risk of seizure from Lybalvi and bupropion |
| fluvoxamine (Luvox) | — | can increase the risk of side effects from Lybalvi and fluvoxamine |
To learn more about Lybalvi’s side effects, see this article.
Certain health conditions or other factors could raise your risk of harm if you take Lybalvi. If this applies to you, your doctor may not prescribe Lybalvi for you. These are known as contraindications. The list below includes contraindications of Lybalvi.
If you currently have opioid withdrawal symptoms: Doctors likely won’t prescribe Lybalvi while you have opioid withdrawal symptoms. These uncomfortable side effects can happen after stopping an opioid on which your body has become dependent. (With dependence, your body needs the drug to feel like it usually does.)
Starting Lybalvi while you have opioid withdrawal may worsen the symptoms. Examples of these symptoms include body aches, diarrhea, and abdominal pain.
If you’re having symptoms of opioid withdrawal, talk with your doctor. They’ll recommend when it’s safe to start Lybalvi treatment or other options for your condition.
If you take opioids: Doctors likely won’t prescribe Lybalvi if you’ve recently taken opioids. This is because taking Lybalvi in this situation could lead to opioid withdrawal (described in the paragraphs just above).
Examples of opioids include:
- buprenorphine (Brixadi, Sublocade, others)
- hydrocodone (Hysingla ER)
- oxycodone (OxyContin, Xtampza ER, others)
Due to this risk, your doctor may delay your Lybalvi treatment. This means you may not start Lybalvi until at least 7–10 days after your last opioid dose.
If you have questions about this, talk with your doctor. They’ll advise you on when it’s safe to begin Lybalvi treatment or other options for your condition.
If you’ve had an allergic reaction: If you’ve had an allergic reaction to Lybalvi or any of its ingredients, your doctor likely won’t prescribe Lybalvi for you. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before you start taking Lybalvi, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Lybalvi is safe for you to take.
You should not take Lybalvi with alcohol. This is because alcohol may worsen certain side effects of Lybalvi. Examples include orthostatic hypotension (feeling lightheaded or dizzy when rising) and sleepiness.
If you have questions about avoiding alcohol while taking Lybalvi, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Lybalvi.
Interaction with certain antihistamines
Lybalvi can interact with certain antihistamines, which some people use to ease symptoms of allergies and colds.
Examples of antihistamine medications include:
- cetirizine (Zyrtec, Quzyttir)
- diphenhydramine (Benadryl)
- meclizine (Antivert, Bonine, others)
What could happen
Lybalvi and certain antihistamines can cause sleepiness by themselves. So taking these drugs together can increase your risk of this side effect.
What you can do
If you’re interested in taking an antihistamine with Lybalvi, talk with your doctor or pharmacist first. They can advise whether these medications are safe to take together. If needed, they can recommend a different treatment to ease symptoms of allergies and colds.
Interaction with certain Parkinson’s disease drugs
Lybalvi can interact with certain Parkinson’s disease drugs, which treat Parkinson’s disease.
Examples of Parkinson’s disease drugs include:
- levodopa (Inbrija)
- carbidopa/levodopa (Rytary, Sinemet, others)
- bromocriptine (Parlodel)
What could happen
Lybalvi and certain Parkinson’s disease drugs may mask each other’s effects. This can happen because of how each drug works in the body. So taking Lybalvi with certain Parkinson’s disease drugs could make both drugs less effective.
What you can do
Before starting Lybalvi treatment, tell your doctor if you take a drug for Parkinson’s disease. They can determine whether it’s safe to take these medications together.
If you have questions about taking Lybalvi with a drug for Parkinson’s disease, talk with your doctor or pharmacist.
Interaction with bupropion
Lybalvi can interact with bupropion (Aplenzin, Wellbutrin XL, others). This drug treats seasonal affective disorder and depression.
What could happen
Lybalvi and bupropion both can cause seizure. So taking these drugs together can raise your risk of this side effect.
What you can do
If you take Lybalvi with bupropion, your doctor may prescribe a dosage of bupropion that’s lower than usual. Doing so can help lower the risk of seizure from either drug. Do not take a dose of either medication that’s higher than your doctor prescribes.
If you have questions about taking Lybalvi with bupropion, talk with your doctor or pharmacist.
Lybalvi may interact with other substances, such as supplements, foods, vaccines, or lab tests. See below for details. Note that the information below does not include all possible interactions with Lybalvi.
Does Lybalvi interact with supplements?
Before you start taking Lybalvi, talk with your doctor and pharmacist about any herbs or vitamins and supplements you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Lybalvi interactions with herbs
Lybalvi may interact with St. John’s wort, which some people use to ease symptoms of depression and other health conditions.
Taking Lybalvi with St. John’s wort could make Lybalvi less effective.
Before you start Lybalvi treatment, tell your doctor if you take St. John’s wort. They may suggest you stop taking it, or they may prescribe a drug other than Lybalvi.
Lybalvi and vitamins
Lybalvi currently has no reports of interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products with Lybalvi.
Does Lybalvi interact with food?
Lybalvi currently has no reports of interacting with food. If you have questions about eating certain foods during your treatment with Lybalvi, talk with your doctor.
Does Lybalvi interact with vaccines?
Lybalvi currently has no reports of interacting with vaccines. If you have questions about getting certain vaccines during your Lybalvi treatment, talk with your doctor.
Does Lybalvi interact with lab tests?
Lybalvi may interfere with the results of urine tests that check for opioids in your body.
Specifically, taking Lybalvi may cause a false-positive result on these tests. This means the test may show opioids in your body even if you’ve not taken any.
Because of this, it’s important to tell the person giving you the test that you’re taking Lybalvi. They may suggest other lab tests for opioids that aren’t affected by Lybalvi.
Does Lybalvi interact with cannabis or CBD?Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been reported to interact with Lybalvi. Taking Lybalvi while using cannabis products may raise your risk of sleepiness from Lybalvi or the cannabis products. (For more information about Lybalvi’s side effects, see this article.)
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 states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Lybalvi. Before taking Lybalvi, talk with your doctor about your health history. They’ll determine whether Lybalvi is right for you.
Health conditions or other factors that might interact with Lybalvi include:
Being an older adult who has psychosis related to dementia: Doctors typically will not prescribe Lybalvi for older adults who have psychosis related to dementia. (Older adults are those ages 65 and older.) This is because Lybalvi has a boxed warning about the increased risk of death in people with these conditions.
A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For more information, see the “Boxed warning” section at the beginning of this article.
Current opioid withdrawal symptoms: Doctors typically will not prescribe Lybalvi for people having opioid withdrawal symptoms. To learn more, see the “When should I avoid Lybalvi?” section above.
High triglyceride or cholesterol levels: Lybalvi may cause high triglyceride or cholesterol levels as a side effect. If you already have high triglyceride or cholesterol levels, this drug could increase them. Your doctor may check your levels more often than usual while you’re taking Lybalvi.
Diabetes: Lybalvi may cause high blood sugar that could worsen your diabetes. If you have diabetes, your doctor may have you check your blood sugar more often while you’re taking Lybalvi.
Severe kidney or liver problems: It is unknown whether Lybalvi is safe for people who have severe kidney or liver problems. Examples of these problems include kidney failure and liver failure.
If you have a severe kidney or liver problem, talk with your doctor before starting Lybalvi treatment. They can recommend the right treatment option for you.
Seizure: Lybalvi may cause seizure. Before taking the drug, tell your doctor if you’ve ever had seizures. They can determine whether Lybalvi is a safe treatment option.
Low white blood cell levels: Lybalvi may lower the levels of white blood cells in your body. This can increase your risk of infection.
Your doctor may check your white blood cell levels before starting Lybalvi treatment. If your levels are low, they may delay your treatment until the levels return to their usual range.
Pregnancy: It is unknown whether Lybalvi is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Lybalvi.
If you do take Lybalvi while pregnant, consider enrolling in the drug’s pregnancy registry. This registry collects details about pregnancy issues reported with Lybalvi. To learn more, call 866-961-2388 or talk with your doctor.
Breastfeeding: Your doctor can recommend whether it’s safe to take Lybalvi while breastfeeding. The drug may pass into breast milk and cause side effects in a child who’s breastfed. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Lybalvi or any of its ingredients, your doctor likely won’t prescribe Lybalvi. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Taking certain steps can help you avoid interactions with Lybalvi. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a
medication list . - What to do if you start taking a new drug during your Lybalvi treatment.
It’s also important to understand Lybalvi’s
If you need help reading or understanding this information, your doctor or pharmacist can help.
Taking Lybalvi exactly as prescribed can also help prevent interactions.
If you still have questions about Lybalvi and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Should I tell you if I start a new medication during Lybalvi treatment?
- Can I take Lybalvi even if it interacts with a health condition I have?
- Do other medications available for my condition have interactions similar to Lybalvi’s?
To learn more about Lybalvi, see these articles:
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Disclaimer: Healthline 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.