Can Wellbutrin (bupropion), Seroquel (quetiapine), and Lamictal (lamotrigine) be given together?

Combination Therapy with Wellbutrin, Seroquel, and Lamictal

Yes, Wellbutrin (bupropion), Seroquel (quetiapine), and Lamictal (lamotrigine) can be given together, but this combination requires careful monitoring for potential interactions and side effects.

Rationale for Combination

This medication combination is commonly used in clinical practice, particularly for patients with bipolar disorder:

• Lamictal (lamotrigine) is FDA-approved for maintenance therapy in adults with bipolar disorder 1
• Seroquel (quetiapine) is FDA-approved for acute mania in adults 1
• Wellbutrin (bupropion) is often used as an adjunctive treatment for depression and has different mechanisms of action than the other medications

Important Interactions to Consider

1. Lamotrigine and Hormonal Contraceptives:

   • Lamotrigine levels may decrease significantly during combined oral contraceptive use 1
   • This interaction is classified as Category 3 (risks may outweigh benefits) when used with hormonal contraceptives 1

2. Bupropion and Serotonergic Medications:

   • While rare, there is a case report of serotonin syndrome when bupropion was combined with SSRIs 2
   • Bupropion can inhibit cytochrome P450 2D6, potentially increasing blood levels of other medications 2

3. Seizure Risk:

   • Bupropion carries a 0.1% seizure risk at therapeutic doses 3
   • Lamotrigine is an anticonvulsant, which may theoretically help mitigate this risk

Clinical Evidence for Efficacy

• A study examining treatment patterns in bipolar depression found that combinations of mood stabilizers (like lamotrigine) with atypical antipsychotics (like quetiapine) are common in clinical practice 4

• Specifically for lamotrigine and quetiapine combination:

  • An open-label study of lamotrigine plus quetiapine in treatment-resistant bipolar depression showed improved outcomes with 46.2% of patients achieving euthymia 5
  • This combination was generally well-tolerated with only 10.3% discontinuing due to adverse effects 5

Monitoring Recommendations

When using this combination, monitor for:

1. Neuropsychiatric symptoms:

   • Depression, suicidal ideation, cognitive changes 3
   • Weekly assessment during the first month of treatment is recommended 3

2. Cardiovascular effects:

   • Bupropion can increase blood pressure and heart rate 3
   • Monitor vital signs regularly

3. Skin reactions:

   • Both lamotrigine and bupropion can cause severe skin reactions
   • Watch for rash, urticaria, or angioedema 3

4. Cognitive effects:

   • Bupropion can cause decreased concentration and memory 3
   • Combined CNS effects may increase this risk

Dosing Considerations

• Start with lower doses and titrate slowly when using this combination
• For lamotrigine specifically, follow established titration protocols to minimize risk of serious rash
• Maximum daily dose of bupropion should not exceed 1 tablet daily in patients with moderate to severe hepatic impairment 3

Conclusion

While this three-drug combination can be used together, it requires careful monitoring and dose adjustment. The combination may be particularly useful in bipolar disorder patients with treatment-resistant depression, where the complementary mechanisms of action may provide better symptom control than monotherapy.