Can Wellbutrin (bupropion) be added to Adderall (amphetamine and dextroamphetamine) for Attention Deficit Hyperactivity Disorder (ADHD) treatment?

Adding Bupropion to Adderall for ADHD Treatment

Bupropion can be added to Adderall for ADHD treatment, particularly when stimulants alone are not providing adequate symptom control, but this combination should be used with careful monitoring for side effects. 1

Efficacy of Combination Therapy

• Bupropion works as a norepinephrine and dopamine reuptake inhibitor, which can complement the mechanism of action of stimulants like Adderall 2
• Adding bupropion to stimulant medication has been speculated by experienced clinicians to potentially enhance the effect on ADHD symptoms 1
• Bupropion has shown efficacy as a monotherapy for ADHD with moderate clinical improvement compared to placebo, though with smaller effect sizes than stimulants 3, 4
• The American Academy of Child and Adolescent Psychiatry notes that no single antidepressant (including bupropion) is proven to effectively treat both ADHD and depression simultaneously 5

Dosing Considerations

• When adding bupropion to Adderall, start with bupropion SR at 100-150 mg daily or XL at 150 mg daily 1
• Bupropion can be titrated to maintenance doses of 100-150 mg twice daily (SR) or 150-300 mg daily (XL) 1
• Maximum recommended dose of bupropion is 450 mg per day 1
• Adderall dosing typically ranges from 10-50 mg daily when used in combination therapy 1

Safety Considerations

• There are no specific warnings against interactions between bupropion and stimulants in FDA labeling 1
• Common side effects to monitor include headache, insomnia, and anxiety, which may be exacerbated when combining these medications 5
• The combination may increase the risk of seizures, particularly at higher doses of bupropion 1
• Careful monitoring for cardiovascular effects is necessary as both medications can affect blood pressure and heart rate 6

Special Populations

• For pregnant patients, stimulants have shown some risks for pregnancy complications, and bupropion may be considered as an alternative to stimulants during pregnancy 1
• Bupropion has been associated with a small increased risk of certain cardiovascular malformations in first-trimester exposure, though data are limited 1
• In patients with substance abuse history, this combination should be used with caution and close monitoring 5

Clinical Approach to Combination Therapy

1. Ensure optimal dosing of Adderall has been achieved before adding bupropion 5
2. Consider adding bupropion particularly if there are comorbid depressive symptoms 1
3. Start with a low dose of bupropion and titrate slowly while monitoring for side effects 1
4. Schedule regular follow-up visits to assess response and monitor for adverse effects 5
5. Consider the combination particularly when:
   • ADHD symptoms persist despite optimal stimulant therapy 1
   • There are comorbid mood symptoms that might benefit from bupropion 1
   • Sleep disturbances from stimulants are problematic 1

Potential Pitfalls

• Avoid this combination in patients with a history of seizures or eating disorders due to increased seizure risk with bupropion 5
• Monitor for increased anxiety, insomnia, or headaches which may be exacerbated by the combination 5
• Be aware that the evidence for this specific combination is limited, with most recommendations based on clinical experience rather than large controlled trials 1, 3
• Avoid concurrent use of MAO inhibitors with either medication due to risk of severe hypertension 5