Can you take Wellbutrin (bupropion) with Lamictal (lamotrigine)?

Concurrent Use of Wellbutrin (Bupropion) and Lamictal (Lamotrigine)

Yes, you can take Wellbutrin (bupropion) with Lamictal (lamotrigine) as there is no significant pharmacokinetic interaction between these medications that would prevent their concurrent use. According to the FDA drug information, multiple oral doses of bupropion had no statistically significant effects on the single-dose pharmacokinetics of lamotrigine in healthy volunteers 1.

Safety Profile of the Combination

The combination of bupropion and lamotrigine is generally considered safe based on available evidence:

• The FDA drug label specifically states that lamotrigine's pharmacokinetics are not significantly affected by bupropion 1
• Neither medication significantly alters the blood levels of the other, reducing concerns about toxicity or reduced efficacy

Therapeutic Considerations

Potential Benefits

• Bupropion is often used as an augmentation strategy for treatment-resistant depression 2
• Lamotrigine is primarily used as a mood stabilizer in bipolar disorder, particularly effective for preventing depressive episodes 3
• The combination may be particularly useful for patients with:
  • Bipolar depression
  • Treatment-resistant depression
  • Comorbid epilepsy and mood disorders

Dosing Considerations

• Standard dosing can be maintained for both medications when used together
• Lamotrigine typically requires slow titration (over 6 weeks) to reach the target dose of 200 mg/day to minimize the risk of serious rash 3
• Bupropion dosing typically starts at 100-150 mg daily and increases by 100 mg every 5-7 days to a maximum of 400 mg daily 2

Important Monitoring Considerations

When using these medications together, monitor for:

1. Seizure risk: While bupropion at therapeutic doses has anticonvulsant properties, at high doses it can lower seizure threshold 4. Careful monitoring is needed, especially during dose adjustments.

2. Skin reactions: Lamotrigine carries a risk of serious rash (0.1% in bipolar disorder studies), including Stevens-Johnson syndrome 3. This risk is not known to be increased by bupropion co-administration.

3. Neuropsychiatric effects: Both medications can cause headache, dizziness, and insomnia. Monitor for additive effects.

Special Precautions

• Pregnancy: Both medications are contraindicated in pregnancy or in women who may become pregnant without adequate contraception
• Renal/Hepatic impairment: Dose adjustments may be required for either medication in patients with significant organ dysfunction
• Drug interactions with other medications: While bupropion and lamotrigine don't significantly interact with each other, they may interact with other medications:
  • Bupropion inhibits CYP2D6, potentially affecting other medications metabolized by this enzyme 1
  • Lamotrigine levels can be significantly decreased by enzyme-inducing anticonvulsants (phenytoin, carbamazepine) or increased by valproate 5

Conclusion

The combination of bupropion and lamotrigine can be safely used together with appropriate monitoring. No specific dose adjustments are required when using these medications concurrently based on their pharmacokinetic profiles.