Can someone take Wellbutrin (bupropion) and Cymbalta (duloxetine) together?

Combining Wellbutrin (Bupropion) and Cymbalta (Duloxetine)

Yes, Wellbutrin (bupropion) and Cymbalta (duloxetine) can be used together, but this combination requires careful monitoring for potential side effects including increased blood pressure, heart rate, and risk of seizures. 1

Safety Considerations

• The combination of bupropion (Wellbutrin) and duloxetine (Cymbalta) is commonly used in clinical practice for treatment-resistant depression or to address different symptom clusters 2
• This combination pairs a norepinephrine-dopamine reuptake inhibitor (bupropion) with a serotonin-norepinephrine reuptake inhibitor (duloxetine), potentially offering complementary mechanisms of action 2
• Bupropion may help counteract some sexual side effects associated with SNRIs like duloxetine 2

Monitoring Requirements

• Blood pressure and heart rate should be regularly monitored as both medications can potentially increase these parameters 1
• The combination may lower seizure threshold, requiring particular caution in patients with a history of seizure disorders 1
• Monitor for signs of serotonin syndrome (confusion, rapid heart rate, dilated pupils, muscle rigidity, agitation) although this is less common with bupropion than with other antidepressant combinations 3

Contraindications

• This combination is contraindicated in:
  • Patients with uncontrolled seizure disorders 1
  • Patients with current or prior diagnosis of bulimia or anorexia nervosa (due to increased seizure risk with bupropion) 1
  • Patients taking monoamine oxidase inhibitors (MAOIs) 4
  • Patients with severe hepatic impairment 4

Dosing Considerations

• Start with lower doses of both medications and titrate gradually 5
• Typical dosing ranges:
  • Bupropion: 150-400 mg/day (usually divided doses) 4
  • Duloxetine: 30-120 mg/day 4
• Allow adequate time between dose adjustments (at least 1 week) to assess for side effects 5

Evidence for Combination Therapy

• Open-label studies suggest that bupropion combined with SNRIs like duloxetine may be effective for patients who have had an inadequate response to monotherapy 2
• A small study examining duloxetine-bupropion combination showed some efficacy in treatment-resistant depression, though results were modest 6
• Earlier research with bupropion combined with SSRIs showed promising results for treatment-resistant depression 7

Potential Side Effects of Combination

• Common side effects may include:
  • Dry mouth, insomnia, headache, constipation 2
  • Nausea, dizziness, increased sweating 4
  • Anxiety or agitation 5
• Less common but serious concerns:
  • Elevated blood pressure and heart rate 1
  • Increased risk of seizures, especially at higher doses 1
  • Rare cases of hepatotoxicity (primarily with duloxetine) 4

Alternative Approaches

• If this combination is not suitable, consider:
  • Sequential trials of each medication as monotherapy before combining 4
  • Different antidepressant combinations with potentially fewer interaction concerns 4
  • Augmentation with non-antidepressant medications (e.g., atypical antipsychotics, mood stabilizers) 4