Bupropion (Wellbutrin®) Interactions
Taking Bupropion with:
Bupropion Drug interactions
- CYP2B6 Inhibitors (e.g. clopidogrel, cyclophosphamide, orphenadrine,
thiotepa, ticlopidine): may increase bupropion plasma levels.
- CYP2D6 Substrates (e.g. thioridazine, tamoxifen): decreased metabolism of CYP2D6 Substrates.
- MAO inhibitors: can be fatal when combined with MAO inhibitors.
- According to the latest reports, there is a potential for digoxin-bupropion drug interaction 4.
Can you take Bupropion and benzodiazepines at the same time?
Bupropion is contraindicated during the abrupt withdrawal from the benzodiazepines because of increased risk of seizures.
However, concomitant use of bupropion and benzodiazepines, e.g. alprazolam (Xanax®), diazepam (Valium®), lorazepam (Ativan®), clonazepam (Klonopin®), temazepam (Restoril®), is not contraindicated 1. So bupropion can be taken along with benzodiazepines, but with great caution and under a doctor's supervision.
Can you take Bupropion and Adderall® (amphetamine/dextroamphetamine) at the same time?
No contraindications/warnings regarding concomitant use 1.
Can you take Bupropion and Methylphenidate (Ritalin®, Concerta®) at the same time?
Concurrent use of bupropion and methylphenidate is not contraindicated. There are two reports that describe grand mal seizures in one patient 5 and myocardial infarction in another 6, which were associated with the concurrent use of bupropion and methylphenidate.
Can you take Bupropion and Phentermine together?
No contraindications/warnings regarding concomitant use of bupropion and phentermine 1.
Can you take Bupropion with Escitalopram (Lexapro®)?
Bupropion can be taken along with escitalopram, but this combination should be used with caution. The combination of escitalopram and bupropion SR may be an effective and well tolerated treatment for major depression 7.
Can you take Bupropion with Fluoxetine (Proxac®)?
Bupropion can be taken along with fluoxetine 9, but this combination should be used with caution and dosage reduction may be needed.
Can you take Bupropion with Paroxetine (Paxil®)?
Bupropion can be taken along with paroxetine 9, but this combination should be used with caution and dosage reduction may be needed.
Can you take Bupropion with Sertraline (Zoloft®)?
Bupropion can be taken along with sertraline 12, but this combination should be used with caution.
Can you take Bupropion with Mirtazapine (Remeron®)?
Concomitant use is not contraindicated. The combination of bupropion plus mirtazapine is well tolerated and effective 8.
Can you take Bupropion with Duloxetine (Cymbalta®)?
Concomitant use is not contraindicated. The combination of bupropion plus duloxetine is sometimes used for treatment-resistant depression 13.
Can you take Bupropion with Tramadol (Ultram®)?
Simultaneous use of bupropion and tramadol may lower the convulsive threshold. Use cautionly.
Can you take Bupropion with Aripiprazole (Abilify®)?
Concomitant use is not contraindicated. In certain cases aripiprazole is used as adjunctive to bupropion in the treatment of depression 11.
Can you take Bupropion and Lorcaserin (Belviq®) at the same time?
Theoretical potential for serotonin syndrome. No contraindications regarding concomitant use of bupropion and lorcaserin 10.
Can you take Bupropion with Varenicline (Champix®) at the same time?
Concomitant use is not contraindiated. Both Bupropion and Varenicline are approved for smoking cessation. These medications work in different ways. Combination treatment with varenicline and bupropion has been proved to be acceptable and effective14.
Bupropion during Pregnancy & Lactation
Pregnancy category C
A slight increase in malformations was observed in some animal studies.
In studies conducted in rats and rabbits, bupropion was administered orally
at doses up to 450 and 150 mg/kg/day, respectively (approximately 11 and
7 times the maximum recommended human dose), during the period of organogenesis.
No clear evidence of teratogenic activity was found in either species;
however, in rabbits, slightly increased incidences of fetal malformations
and skeletal variations were observed.
One study has been conducted in pregnant women. This retrospective, managed-care
database study assessed the risk of congenital malformations overall,
and cardiovascular malformations specifically, following exposure to bupropion
in the first trimester compared to the risk of these malformations following
exposure to other antidepressants in the first trimester and bupropion
outside of the first trimester. The study showed no greater risk for
congenital malformations overall, or cardiovascular malformations specifically,
following first trimester bupropion exposure compared to exposure to all
other antidepressants in the first trimester, or bupropion outside of
the first trimester. The results of this study have not been corroborated.
Bupropion and its metabolites are secreted in human milk. Because of the potential harm for nursing infants,
a decision should be made whether to discontinue nursing or to discontinue Bupropion.
When Bupropion (Wellbutrin) is a good choice?
Those who experience cravings, excessive eating, attention deficit hyperactivity disorder (ADHD), low libido, orgasm dysfunction 2, lethargy, or lack of motivation 3 may benefit from bupropion. It is a worthy choice if tobacco cessation or weight loss is a secondary goal. It may help to overcome retarded depression, depression with coexisting cognitive slowing or pseudo-dementia.
When you should not take Bupropion (Wellbutrin)?
Bupropion is not a prescription of choice for excessively activated and agitated persons, those who use any other bupropion-containing product (ie, coadministration of Zyban for smoking cessation and Wellbutrin for depression).
It is contraindicated for those who have:
- seizure disorder
- current or prior diagnosis of bulimia or anorexia nervosa
- been concurrently treated with or within 14 days of discontinuation of MAO inhibitors
- abruptly discontinued alcohol or sedatives
- hypersensitivity to bupropion or any other component of the product.
- 1. U.S. FDA. Bupropion SR Prescribing Information (PDF format)
- 2. Modell JG, May RS, Katholi CR. J Sex Marital Ther. 2000 Jul-Sep;26(3):231-40. PubMed
- 3. Jamerson BD, Krishnan KR, Roberts J, Krishen A, Modell JG. Psychopharmacol Bull. 2003 Spring;37(2):67-78. PubMed
- 4. He J, Yu Y, Prasad B, Chen X, Unadkat JD. Mechanism of an unusual, but clinically significant, digoxin-bupropion drug interaction. Biopharm Drug Dispos. 2014 Jan 16.
- 5. Ickowicz A. Bupropion-methylphenidate combination and grand mal seizures. Can J Psychiatry. 2002 Oct;47(8):790-1.
- 6. George AK, Kunwar AR, Awasthi A. Acute myocardial infarction in a young male on methylphenidate, bupropion, and erythromycin. J Child Adolesc Psychopharmacol. 2005 Aug;15(4):693-5.
- 7. Leuchter AF1, Lesser IM, Trivedi MH, et al. An open pilot study of the combination of escitalopram and bupropion-SR for outpatients with major depressive disorder. J Psychiatr Pract. 2008 Sep; 14(5):271-80. PubMed
- 8. Blier P, Ward HE, Tremblay P, Laberge L, Hébert C, Bergeron R. Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. Am J Psychiatry. 2010 Mar;167(3):281-8. PubMed
- 9. Kennedy SH, McCann SM, Masellis M, McIntyre RS, Raskin J, McKay G, Baker GB. Combining bupropion SR with venlafaxine, paroxetine, or fluoxetine: a preliminary report on pharmacokinetic, therapeutic, and sexual dysfunction effects. J Clin Psychiatry. 2002 Mar;63(3):181-6. PubMed
- 10. U.S. FDA. BELVIQ Prescribing Information
- 11. Clayton AH, Baker RA, Sheehan JJ, Cain ZJ, Forbes RA, Marler SV, Marcus R, Berman RM, Thase ME. Comparison of adjunctive use of aripiprazole with bupropion or selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors. BMC Res Notes. 2014 Jul 18;7:459. doi: 10.1186/1756-0500-7-459. PubMed
- 12. Marshall RD, Johannet CM, Collins PY, Smith H, Kahn DA, Douglas CJ. Bupropion and sertraline combination treatment in refractory depression. J Psychopharmacol. 1995 Jan;9(3):284-6. PubMed
- 13. Papakostas GI, Worthington JJ, Iosifescu DV, Kinrys G, Burns AM, Fisher LB, Homberger CH, Mischoulon D, Fava M. The combination of duloxetine and bupropion for treatment-resistant major depressive disorder. Depress Anxiety. 2006;23(3):178-81. PubMed
- 14. Rose JE, Behm FM. Combination treatment with varenicline and bupropion in an adaptive smoking cessation paradigm. Am J Psychiatry. 2014 Nov 1;171(11):1199-205 PubMed