Combining Bupropion, Lithium, and Aripiprazole
Yes, bupropion (Wellbutrin) 150mg, lithium 300mg twice daily, and aripiprazole (Abilify) 15mg can be taken together, but this combination requires careful monitoring for potential interactions and side effects. 1
Safety of This Medication Combination
This medication combination is used in clinical practice for treatment-resistant depression and bipolar disorder. Each medication has distinct mechanisms of action:
- Bupropion (Wellbutrin): Acts as a norepinephrine-dopamine reuptake inhibitor
- Lithium: Mood stabilizer primarily used for bipolar disorder
- Aripiprazole (Abilify): Atypical antipsychotic that can augment antidepressant effects
Research supports the use of aripiprazole as an adjunctive treatment with bupropion for treatment-resistant depression 2. Similarly, lithium is often combined with other psychiatric medications for enhanced efficacy.
Monitoring Requirements
When taking this combination, the following monitoring is essential:
- Seizure risk: Bupropion lowers the seizure threshold 3. The risk increases with higher doses, so maintaining the 150mg dose is important.
- Lithium levels: Regular blood tests to monitor lithium levels are crucial to prevent toxicity.
- Metabolic parameters: Monitor for weight changes and metabolic effects, particularly with aripiprazole.
- Neurological symptoms: Watch for tremor, which can occur with both lithium and bupropion 1, 4.
Potential Side Effects and Interactions
Common side effects to be aware of:
- Bupropion: Insomnia, dry mouth, headache, nausea 1, 3
- Lithium: Tremor, increased thirst, frequent urination, potential thyroid and kidney effects
- Aripiprazole: Akathisia, insomnia, weight gain 2
While there are no absolute contraindications to this specific combination, be aware that:
- Bupropion inhibits CYP2D6, which could potentially affect the metabolism of other medications 3.
- The combination may increase the risk of neurological side effects such as tremor or akathisia.
- Inadvertent extra doses of bupropion should be avoided as they significantly increase adverse effect risk 4.
Dosing Considerations
- Bupropion: The 150mg dose is at the lower end of the therapeutic range (150-300mg daily) 5, which may help minimize side effects in this combination.
- Lithium: 300mg twice daily is a common dosing regimen, but lithium dosing should always be guided by serum levels.
- Aripiprazole: 15mg is within the typical dosing range for adjunctive treatment of depression.
Important Precautions
This combination should be avoided in patients with:
- History of seizures or conditions that lower seizure threshold
- Significant kidney or thyroid dysfunction
- Recent discontinuation of alcohol or sedatives
If side effects occur, dosage adjustments should be made one medication at a time to identify the cause.
Abrupt discontinuation of any of these medications should be avoided; gradual tapering is recommended to minimize withdrawal symptoms 1.