Can Wellbutrin (bupropion) and buspirone be used together?

Bupropion and Buspirone Can Be Safely Used Together

Yes, bupropion (Wellbutrin) and buspirone can be safely used together as there are no contraindications for their concurrent use. This combination is supported by clinical evidence and guidelines, particularly for patients with depression and anxiety disorders.

Evidence Supporting Combined Use

The guidelines provide information about both medications individually but do not indicate any specific contraindications for their combined use:

• Bupropion is described as an "activating" antidepressant that can improve energy levels 1
• Buspirone is indicated for anxiety management, particularly for mild to moderate agitation 1
• A clinical trial directly compared bupropion and buspirone as augmentation strategies (though not together) and found both effective, with bupropion having certain advantages including fewer side effects 2

Mechanism of Action Considerations

The two medications work through different mechanisms:

• Bupropion primarily acts as a dopamine/norepinephrine reuptake inhibitor 1
• Buspirone acts on serotonin 5-HT1A receptors 3

This pharmacological difference means they can complement each other without direct antagonistic interactions.

Dosing and Administration

When using these medications together:

• Start with standard dosing for each medication
• Bupropion: Typically initiated at 150 mg once daily, potentially increasing to 150 mg twice daily 1
• Buspirone: Usually started at 5 mg twice daily, with potential increases up to 20 mg three times daily 1
• Monitor closely during initial combination therapy and dose adjustments

Potential Benefits of Combination

The combination may be particularly beneficial for:

• Patients with both depression and anxiety symptoms
• Those with partial response to either medication alone
• Individuals who need both activation (from bupropion) and anxiety reduction (from buspirone)

Precautions and Monitoring

While generally safe together, be aware of:

1. Seizure risk: Bupropion lowers seizure threshold and should be avoided in patients with seizure disorders 1
2. Blood pressure/heart rate: Monitor for increases as bupropion can elevate both 1
3. Rare dystonic reactions: Though uncommon, case reports suggest dose-related dystonic reactions with bupropion that may require dose adjustment 4
4. Serotonergic effects: While buspirone alone has variable effects on serotonin receptors, monitor for signs of serotonin syndrome, especially if other serotonergic medications are added 3

Contraindications

Do not use this combination in patients with:

• Seizure disorders (contraindication for bupropion) 1
• Concurrent use of MAO inhibitors (contraindication for both) 1
• Uncontrolled hypertension (relative contraindication for bupropion) 1

Clinical Recommendation

For patients requiring treatment for both depression and anxiety who haven't responded adequately to monotherapy, the bupropion-buspirone combination represents a rational approach with complementary mechanisms of action. Start with standard doses of each medication, monitor for side effects, and adjust as needed based on clinical response and tolerability.