Adding Stimulants to Auvelity: Safety Considerations
You can add mixed amphetamine salts to Auvelity, but this requires careful monitoring due to the CNS stimulant interaction warning in the Auvelity label and the lack of specific safety data for this combination. 1
Key Safety Concerns
The Auvelity FDA label explicitly lists "CNS stimulants" among medications requiring special attention when combined with the drug 1. While this doesn't constitute an absolute contraindication, it signals the need for heightened vigilance. The label states you must "tell your healthcare provider about all the medicines you take" and specifically mentions CNS stimulants as requiring discussion about safety 1.
Why This Combination May Be Reasonable
Bupropion (one component of Auvelity) has been safely combined with stimulants in clinical practice. Historical ADHD treatment guidelines note that "there are no studies of the combination of bupropion and stimulants in the treatment of ADHD or other psychiatric conditions" but importantly state "the PDR does not warn against interactions between bupropion and stimulants, and we could locate no case reports of side effects when these agents were combined" 2. The guideline concludes that "clinicians should proceed with caution in combining these agents until further studies are available" 2.
The dextromethorphan component of Auvelity has even been studied as an add-on to methylphenidate in children with ADHD, demonstrating efficacy and tolerability 3. This suggests the dextromethorphan-stimulant combination itself is not inherently problematic.
Specific Monitoring Requirements
When combining these medications, monitor for:
- Blood pressure and heart rate elevations: Both Auvelity and amphetamines can increase blood pressure 1, 4. Check baseline vitals and monitor regularly (at minimum monthly initially)
- Seizure risk: Auvelity carries seizure warnings, and this risk may theoretically increase with stimulant co-administration 1
- Psychiatric symptoms: Watch for new or worsening anxiety, agitation, or manic symptoms, as both medications can precipitate these 1, 4
- Sleep disturbances and appetite suppression: Additive effects are likely 5
Practical Implementation
Start the amphetamine at the lowest effective dose while maintaining your current Auvelity regimen. The mixed amphetamine salts label recommends starting at 2.5-5 mg 2. Schedule a follow-up within 2-4 weeks to assess response and tolerability, checking blood pressure and pulse at each visit 2.
Important Caveats
Do not combine if you have: a seizure disorder, eating disorder, uncontrolled hypertension, or significant cardiovascular disease, as both medications carry warnings for these conditions 1, 4. The combination would compound these risks.
The absence of formal drug interaction studies means we're relying on clinical experience and mechanistic reasoning rather than robust evidence. However, the individual safety profiles and clinical practice patterns suggest this combination can be managed safely with appropriate monitoring 2, 1.