Switching from Wellbutrin to Strattera for ADHD While Continuing Prozac
Yes, you can add Strattera (atomoxetine) and discontinue Wellbutrin (bupropion) while continuing Prozac (fluoxetine) 10mg for ADHD treatment, but you should be aware that Prozac may increase Strattera levels requiring careful dosing. 1, 2
Medication Switch Rationale
Atomoxetine (Strattera) is an FDA-approved non-stimulant medication specifically for ADHD treatment with strong evidence supporting its efficacy:
- Atomoxetine has demonstrated effectiveness for ADHD symptoms with an effect size of approximately 0.7 1
- It is considered a second-line treatment when stimulants aren't suitable 3
- Atomoxetine works through a different mechanism than Wellbutrin, targeting norepinephrine reuptake inhibition specifically 4
Important Drug Interaction Considerations
When combining Strattera with Prozac, be aware of these critical interactions:
- Fluoxetine (Prozac) inhibits CYP2D6 enzymes that metabolize atomoxetine
- This interaction can increase atomoxetine blood levels and potentially side effects
- Lower starting doses of Strattera may be needed when combined with Prozac
Implementation Plan
Starting Strattera:
- Begin with a lower dose than typical (e.g., 25mg daily) due to the Prozac interaction
- Gradually increase dose based on response and tolerability
- Full therapeutic effect may take 2-4 weeks to develop 4
Discontinuing Wellbutrin:
- Taper Wellbutrin gradually over 10-14 days to minimize withdrawal symptoms 5
- Consider overlapping Strattera initiation with Wellbutrin taper
Continuing Prozac:
- Maintain your current 10mg dose of Prozac
- This combination can be beneficial if you have comorbid mood symptoms 6
Benefits of This Approach
- Atomoxetine has shown efficacy for ADHD symptoms even in patients with comorbid mood disorders 6
- Research indicates atomoxetine can improve depressive symptoms in addition to ADHD symptoms 6
- The combination may provide better coverage for both ADHD and mood symptoms than Wellbutrin alone
Monitoring Recommendations
- Schedule follow-up visits every 3-4 weeks during the transition period
- Monitor for:
- Blood pressure and heart rate changes (atomoxetine can affect these)
- Sleep quality and patterns
- Appetite and weight changes
- Mood changes or irritability
- Effectiveness of ADHD symptom control
Potential Challenges
- Atomoxetine requires daily compliance for effectiveness 4
- Full therapeutic benefits may take several weeks to achieve
- Side effects may include nausea, decreased appetite, fatigue, or mood changes
- The Prozac-Strattera combination may require dose adjustments to minimize side effects
This medication change is supported by clinical evidence and represents a rational approach for managing ADHD while maintaining treatment for mood symptoms.