What are your thoughts on using a low dose of Adderall (amphetamine and dextroamphetamine) in combination with Wellbutrin (bupropion) 450mg?

Combining Low Dose Adderall with Wellbutrin 450mg

The combination of low dose Adderall (amphetamine and dextroamphetamine) with Wellbutrin (bupropion) 450mg should be approached with caution due to potential additive effects on the central nervous system, though it may be beneficial in specific cases of refractory ADHD symptoms.

Pharmacological Considerations

• Both medications affect dopamine and norepinephrine neurotransmission:

  • Adderall directly increases the release of these neurotransmitters
  • Bupropion inhibits their reuptake, with modest efficacy for ADHD compared to stimulants 1

• Potential concerns with this combination:

  • Increased risk of seizures (bupropion is dose-related for seizure risk) 2
  • Potential for elevated blood pressure and heart rate 2
  • Increased risk of insomnia, anxiety, and agitation 2
  • Possible additive appetite suppression effects

Evidence for Combination Therapy

The American Academy of Child and Adolescent Psychiatry notes there are no specific studies of the combination of bupropion and stimulants in the treatment of ADHD, stating: "There are no studies of the combination of bupropion and stimulants in the treatment of ADHD or other psychiatric conditions" 3.

However, clinical experience suggests:

• Combined medication with stimulants and non-stimulants may facilitate treatment adherence for ADHD 4
• The main indication for combination therapy is often dose-limiting side effects of either medication alone 4

When This Combination May Be Considered

1. Patients with partial response to maximum tolerated dose of either medication alone
2. Patients who experience dose-limiting side effects with higher doses of either medication
3. Patients with comorbid depression and ADHD, as bupropion has antidepressant effects 1

Safety Precautions

If considering this combination:

1. Start with lower doses of both medications:

   • Begin with the lowest effective dose of Adderall while maintaining Wellbutrin
   • Titrate slowly while monitoring for side effects

2. Monitor closely for:

   • Seizures (bupropion carries a dose-related seizure risk) 2
   • Blood pressure and heart rate changes 2
   • Psychiatric symptoms (anxiety, agitation, insomnia) 2
   • Weight loss and appetite changes

3. Contraindications:

   • History of seizures
   • Current or prior diagnosis of bulimia or anorexia nervosa
   • Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs 2

Alternative Approaches

If concerned about the combination:

1. Optimize one medication first:

   • Try maximum tolerated dose of either medication before combining
   • Consider extended-release formulations for better coverage

2. Consider other non-stimulant options:

   • Atomoxetine may be preferred for patients with substance use disorders or risk of stimulant abuse 1
   • Guanfacine or clonidine extended-release are FDA-approved as adjunctive therapy to stimulants 1

Conclusion

While the combination of low-dose Adderall with Wellbutrin 450mg is not explicitly contraindicated, it requires careful consideration of risks versus benefits. The high dose of Wellbutrin (450mg) already carries an increased seizure risk, so adding a stimulant requires particularly careful monitoring. If this combination is pursued, start with the lowest effective dose of Adderall, monitor closely for adverse effects, and be prepared to discontinue if significant side effects emerge.