Is it safe to use Wellbutrin (bupropion) and Vyvanse (lisdexamfetamine) together?

Safety of Combining Wellbutrin (Bupropion) and Vyvanse (Lisdexamfetamine)

The combination of Wellbutrin (bupropion) and Vyvanse (lisdexamfetamine) should be used with caution due to potential additive stimulant effects that may increase the risk of cardiovascular side effects and neuropsychiatric symptoms.

Mechanism and Concerns

Both medications affect similar neurotransmitter systems:

• Bupropion inhibits the reuptake of norepinephrine and dopamine 1
• Lisdexamfetamine is a stimulant that increases dopamine and norepinephrine levels
• This overlap creates potential for additive effects, particularly:
  • Increased blood pressure and heart rate
  • Heightened anxiety/jitteriness
  • Increased risk of seizures
  • Insomnia and other neuropsychiatric effects

Risk Assessment and Monitoring

When this combination is deemed necessary, implement the following monitoring protocol:

1. Cardiovascular monitoring:

   • Check blood pressure and heart rate before initiating therapy
   • Monitor regularly during the first 12 weeks of treatment 1
   • Continue periodic monitoring throughout treatment
   • Avoid in patients with uncontrolled hypertension 1

2. Neuropsychiatric monitoring:

   • Assess for increased anxiety, agitation, and insomnia
   • Monitor for emergence or worsening of suicidal thoughts, especially in patients under 24 years 1
   • Watch for signs of seizure activity, particularly in patients with risk factors

3. Dosing considerations:

   • Consider starting with lower doses of both medications
   • Titrate slowly while monitoring for side effects
   • For patients with moderate to severe renal impairment, reduce bupropion dose by 50% 1
   • For patients with hepatic impairment, bupropion should not exceed 1 tablet daily 1

Special Populations

Extra caution is warranted in:

• Patients with seizure disorders (contraindication for bupropion) 1
• Patients with cardiovascular conditions
• Elderly patients (consider lower starting doses) 1
• Patients with renal or hepatic impairment 1
• Patients with anxiety disorders (bupropion may exacerbate symptoms) 1

Clinical Considerations

While specific research on the bupropion-lisdexamfetamine combination is limited, clinical experience with bupropion in combination with other medications provides relevant insights:

• Bupropion has been successfully combined with serotonergic agents like SSRIs and SNRIs for treatment-resistant depression 1, 2, 3, 4
• These combinations require careful monitoring, particularly for cardiovascular effects and seizure risk 1
• The stimulating properties of bupropion can trigger anxiety-like symptoms 1

Common Pitfalls to Avoid

1. Overlooking contraindications:

   • Never combine with MAOIs 1
   • Avoid in patients with seizure disorders or conditions that lower seizure threshold 1
   • Use cautiously in patients with uncontrolled hypertension 1

2. Inadequate monitoring:

   • Failure to monitor blood pressure and heart rate regularly
   • Not watching for neuropsychiatric symptoms
   • Missing early signs of adverse effects

3. Improper discontinuation:

   • If discontinuation is necessary, gradually taper bupropion with a reduction to 150mg once daily for 1-2 weeks before complete discontinuation 1
   • Abrupt discontinuation may lead to withdrawal symptoms

The decision to use this combination should be based on a careful assessment of potential benefits versus risks, with implementation of appropriate monitoring protocols to ensure patient safety.