What is the interaction between Abilify (aripiprazole) and Wellbutrin (bupropion)?

Interaction Between Abilify (Aripiprazole) and Wellbutrin (Bupropion)

Bupropion and aripiprazole can be used together, but require monitoring for increased risk of seizures, akathisia, and potential drug interactions through CYP2D6 inhibition.

Pharmacological Interaction Mechanism

• Bupropion is a dopamine-norepinephrine reuptake inhibitor that can inhibit CYP2D6 enzyme 1
• Aripiprazole is metabolized partially through the CYP2D6 pathway 2
• When combined, bupropion may increase aripiprazole levels by inhibiting its metabolism

Clinical Implications of the Interaction

Potential Benefits

• The combination can be therapeutically beneficial in treatment-resistant depression
• Adjunctive aripiprazole with bupropion has shown rapid improvement in depressive symptoms in patients with bupropion-resistant depression 3
• Recent research indicates that bupropion augmentation may be associated with lower risk of depression-related hospitalization compared to aripiprazole augmentation 4

Adverse Effects and Risks

Seizure Risk

• Bupropion carries a dose-dependent risk of seizures 2
• The combination may potentially increase seizure risk, particularly at higher doses
• Maximum daily dose of bupropion should not exceed 300 mg when used with aripiprazole to minimize seizure risk 2

Movement Disorders

• Akathisia is a common side effect with aripiprazole (23.6% when combined with SSRIs/SNRIs) 5
• Bupropion augmentation is associated with lower risk of movement disorders compared to aripiprazole augmentation 4
• If akathisia develops, consider lowering the aripiprazole dose 3

Metabolic Effects

• Weight gain may occur with both medications
• Mean weight change of +3.1 kg has been observed with bupropion plus aripiprazole over 52 weeks 5
• Monitor for changes in fasting glucose and cholesterol 5

Monitoring Recommendations

Initial Assessment

• Baseline assessment should include:
  • Seizure risk factors
  • Cardiovascular status (blood pressure, heart rate)
  • Metabolic parameters (weight, fasting glucose, lipid profile)
  • Mental status examination

Ongoing Monitoring

• Regular monitoring for:
  • Movement disorders, particularly akathisia
  • Weight changes
  • Metabolic parameters
  • Neuropsychiatric symptoms
  • Therapeutic efficacy

Dosing Considerations

• When using both medications together:
  • Consider starting with lower doses of aripiprazole (2.5-5 mg daily) 3
  • Maintain bupropion at moderate doses (150-300 mg daily) 2
  • Titrate slowly based on response and tolerability
  • Avoid abrupt discontinuation of either medication 2

Contraindications

• Absolute contraindications for this combination include:
  • History of seizure disorders
  • Brain metastases (due to increased seizure risk)
  • Concurrent use of MAO inhibitors (requires 14-day washout period) 2

Special Populations

• Use with caution in:
  • Elderly patients (start with lower doses)
  • Patients with liver or kidney dysfunction
  • Patients with cardiovascular disease
  • Poor metabolizers of CYP2D6 2

This combination can be effective for treatment-resistant depression but requires careful monitoring for potential adverse effects and drug interactions.