Can Strattera (atomoxetine) and Wellbutrin (bupropion) be taken together?

Strattera (Atomoxetine) and Wellbutrin (Bupropion) Combination Therapy

Yes, Strattera (atomoxetine) and Wellbutrin (bupropion) can be safely taken together, though careful monitoring is recommended due to limited research on this specific combination. 1

Pharmacological Rationale

• Both medications work through different but complementary mechanisms - atomoxetine primarily affects norepinephrine reuptake, while bupropion affects dopamine and norepinephrine reuptake 2
• The combination may provide more comprehensive symptom relief than either medication alone for patients with ADHD or comorbid conditions 2
• This combination follows the principle of targeting different neurotransmitter pathways simultaneously, which can have additive therapeutic effects 1

Dosing Guidelines

Atomoxetine (Strattera)

• Initial dose: 40 mg orally once daily 1, 3
• Titration: Adjust dose every 7-14 days, typically to 60 mg then 80 mg daily 1, 3
• Maximum dose: The lesser of 1.4 mg/kg/day or 100 mg/day 1, 3

Bupropion (Wellbutrin)

• For SR formulation: Start with 100-150 mg once daily, maintenance dose 100-150 mg twice daily 1
• For XL formulation: Start with 150 mg once daily, maintenance dose 150-300 mg once daily 1
• Maximum dose: 450 mg per day 1

Monitoring Considerations

• Monitor for neuropsychiatric effects as both medications carry warnings about potential mood changes, though these are uncommon 1
• Watch for insomnia, which can be a side effect of both medications 1, 4
• Monitor for changes in blood pressure and heart rate, as both medications can affect cardiovascular parameters 1
• Be alert for signs of seizures, as bupropion has a dose-related seizure risk (contraindicated in patients with seizure disorders) 1

Clinical Evidence

• Case reports have documented successful use of atomoxetine in combination with stimulants for ADHD, suggesting combination therapy with different mechanisms can be effective 2
• Studies on bupropion combinations with other psychiatric medications (such as SSRIs) have shown generally good tolerability 5, 4
• The combination approach is supported by the principle that targeting multiple neurotransmitter systems can provide more comprehensive symptom relief 1

Potential Advantages of Combination

• May extend duration of symptom relief compared to monotherapy 2
• Could address a wider range of symptoms than either agent alone 2
• Useful for patients with partial response to either medication as monotherapy 4

Cautions and Contraindications

• Bupropion is contraindicated in patients with seizure disorders, stroke, brain metastases, or those taking MAO inhibitors 1
• Both medications require monitoring for neuropsychiatric effects, though recent studies suggest these risks may be lower than previously thought 1
• Start with lower doses of each medication when using in combination and titrate gradually to minimize side effects 2

Important Clinical Pitfalls to Avoid

• Don't start both medications simultaneously - begin with one, stabilize, then add the second 2
• Avoid maximum doses of both medications when used in combination unless clearly necessary 2
• Don't continue the combination if no additional benefit is observed after an adequate trial period (typically 4-8 weeks) 6
• Be cautious in patients with cardiovascular conditions as both medications can affect heart rate and blood pressure 1