From the FDA Drug Label
7.2 Drugs Having No Clinically Important Interactions with Aripiprazole Based on pharmacokinetic studies, no dosage adjustment of aripiprazole is required when administered concomitantly with ... substrates of CYP2D6 (e.g., dextromethorphan, fluoxetine, paroxetine, or venlafaxine)
- Bupropion is a substrate of CYP2D6.
- The FDA label does not explicitly mention bupropion, but it does mention other substrates of CYP2D6, implying that no dosage adjustment of aripiprazole is required when co-administered with these drugs.
- However, bupropion can inhibit CYP2D6, which may increase the exposure of aripiprazole.
- Given the potential interaction, it is recommended to monitor the patient for increased adverse effects of aripiprazole when co-administered with bupropion.
- The FDA label does not provide a clear recommendation for the concomitant use of aripiprazole and bupropion, therefore caution should be exercised when co-administering these drugs 1.
From the Research
Bupropion and aripiprazole (Abilify) can generally be taken together, but this combination should only be used under medical supervision. These medications work differently in the brain - bupropion primarily affects norepinephrine and dopamine, while aripiprazole works on dopamine and serotonin receptors. The combination is sometimes prescribed for treatment-resistant depression or when a patient has both depression and symptoms that might benefit from aripiprazole.
Key Considerations
- Both medications can lower the seizure threshold, potentially increasing seizure risk, especially at higher doses of bupropion 2.
- They may also both affect heart rhythm in some individuals.
- Additionally, there's a small risk of developing movement disorders when these medications are combined.
- Side effects might include increased anxiety, insomnia, agitation, or headaches.
Dosage and Monitoring
- Dosing typically starts low and increases gradually while monitoring for side effects.
- Any unusual symptoms should prompt immediate contact with your healthcare provider.
- Regular follow-up appointments are essential to monitor effectiveness and adjust dosing as needed.
Evidence Support
- A study from 2014 found that combining bupropion with mood stabilizers and atypical antipsychotics may be a good therapeutic option in short-term treatment of depressed bipolar disorder type I patients with comorbid cocaine dependence 3.
- Another study from 2014 assessed the safety, tolerability, and effectiveness of long-term treatment with aripiprazole adjunctive to either bupropion or selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) in patients with major depressive disorder (MDD) 4.
- The most recent study from 2023 reviews the pharmacokinetic and pharmacodynamic effects of bupropion and its mechanisms of action and interactions with other drugs, including its use in treating depression, Attention Deficit Hyperactivity Disorder (ADHD), and smoking cessation 2.