Can you take hydroxyzine with Buspar (buspirone), Lexapro (escitalopram), and Wellbutrin (bupropion)?

Hydroxyzine Can Be Taken with Buspirone, Escitalopram, and Bupropion

Yes, hydroxyzine can generally be taken with buspirone (Buspar), escitalopram (Lexapro), and bupropion (Wellbutrin), but careful monitoring for side effects is necessary.

Medication Interactions and Safety Profile

Hydroxyzine with Escitalopram (Lexapro)

• Hydroxyzine is an antihistamine with anxiolytic properties that can be used alongside SSRIs like escitalopram
• While both medications can cause sedation, there are no major contraindications to their combined use
• Escitalopram is generally well-tolerated with some patients experiencing nausea and sleep disturbances 1

Hydroxyzine with Bupropion (Wellbutrin)

• Bupropion is an activating antidepressant that can improve energy levels
• The sedating effects of hydroxyzine may actually help balance the activating effects of bupropion
• Bupropion should be taken earlier in the day (before 3 PM for second dose) to minimize insomnia risk 1

Hydroxyzine with Buspirone (Buspar)

• Research has shown hydroxyzine and buspirone can be used together safely
• A comparative study demonstrated both medications are effective for anxiety with different side effect profiles 2
• Buspirone takes 2-4 weeks to become effective for anxiety symptoms 1

Potential Side Effects to Monitor

Sedation and CNS Depression

• The most significant concern with this combination is additive sedation
• Hydroxyzine has sedating properties that may compound with any sedating effects from escitalopram
• The FDA has issued warnings about combining medications with sedating effects, particularly when opioids are involved 1

Timing Considerations

• Take bupropion earlier in the day to prevent insomnia
• Hydroxyzine may be better taken in the evening due to its sedating properties
• Space medications throughout the day to minimize peak sedation effects

Dosing Considerations

1. Start with lower doses of each medication when using in combination
2. Gradually increase doses based on response and tolerability
3. Monitor for excessive sedation, especially when initiating treatment
4. Consider:
   • Hydroxyzine: Typically dosed 25-50 mg 3-4 times daily for anxiety
   • Buspirone: Starting at 5 mg twice daily, can increase to maximum of 20 mg three times daily 1
   • Escitalopram: Usually 10-20 mg daily
   • Bupropion: Typically 150 mg twice daily, with second dose before 3 PM 1

Special Precautions

• Avoid alcohol consumption which can increase sedation risk
• Be cautious when driving or operating machinery until you know how this combination affects you
• Report any unusual symptoms to your healthcare provider promptly
• While there is a theoretical risk of serotonin syndrome with buspirone and escitalopram combination, this is rare at standard doses 3

This medication combination addresses both anxiety and depression through different mechanisms of action, which may provide more comprehensive symptom relief than any single medication alone.