From the Research
Combining lamotrigine with both bupropion (Wellbutrin) and fluoxetine (Prozac) requires careful medical supervision due to potential drug interactions, and the most recent evidence suggests that fluoxetine can increase lamotrigine blood levels, potentially leading to serious side effects 1.
Potential Interactions
- Fluoxetine can inhibit the metabolism of lamotrigine, potentially increasing lamotrigine blood levels by 50-100%, which raises the risk of side effects including rash, dizziness, headache, and in rare cases, serious skin reactions like Stevens-Johnson syndrome.
- Bupropion generally has minimal direct interaction with lamotrigine, but the combination may increase the risk of seizures in susceptible individuals since both medications can affect seizure threshold.
- All three medications can cause neurological side effects that might compound when used together, potentially resulting in increased dizziness, headache, or cognitive effects.
Clinical Considerations
- If this combination is prescribed, lamotrigine dosing may need adjustment (typically reduced) when adding fluoxetine, and patients should be monitored closely for side effects.
- Any unusual symptoms, particularly skin rashes, should prompt immediate medical attention.
- The combination of bupropion and SSRIs, such as fluoxetine, can increase the risk of serotonin syndrome, a potentially life-threatening condition 2, 3, 4.
Monitoring and Supervision
- This combination should only be used under careful physician supervision with regular monitoring.
- Therapeutic drug monitoring (TDM) may be beneficial in optimizing lamotrigine therapy and minimizing adverse drug reactions 1.
- Patients should be educated on the potential risks and benefits of this combination and should be closely monitored for any signs of adverse effects.