Is bupropion (Wellbutrin) 150mg with Vraylar (cariprazine) helpful for treating sexual dysfunction, specifically decreased libido?

Bupropion 150mg with Vraylar for Sexual Dysfunction

Bupropion 150mg can be helpful for improving sexual desire and function, including libido, and should be considered as a treatment option for sexual dysfunction. 1, 2 However, there is no evidence that combining it with Vraylar (cariprazine) provides any additional benefit for sexual function, and this combination should be evaluated based on the psychiatric indication for Vraylar rather than sexual enhancement.

Evidence for Bupropion's Effect on Sexual Function

Bupropion has demonstrated efficacy in improving multiple aspects of sexual function, particularly desire and arousal:

• In women with hypoactive sexual desire disorder (HSDD), bupropion was nearly three times more effective than placebo in improving sexual desire problems 3
• The 150mg dose appears more effective than 300mg for improving sexual desire in women with HSDD 3
• Bupropion successfully reversed sexual dysfunction in 66% of patients experiencing antidepressant-induced sexual problems 4
• In non-depressed individuals with orgasmic dysfunction, 70% reported improvement in libido, arousal, or orgasmic function with bupropion 5
• Both women and men showed significant improvements in overall sexual satisfaction, with women experiencing enhanced satisfaction with orgasm intensity on 150mg daily 5

Clinical Guidelines Support Bupropion Use

Multiple expert guidelines recognize bupropion as a treatment option for sexual dysfunction:

• The National Comprehensive Cancer Network (NCCN) considers bupropion an off-label option for women with HSDD, despite limited safety and efficacy data in some populations 2, 6
• Bupropion is significantly less likely to cause sexual dysfunction compared to SSRIs and should be considered first-line when sexual side effects are a concern 1
• Small studies suggest bupropion may improve sexual function in breast cancer survivors, though larger trials are needed 7

Mechanism and Dosing

Bupropion works through norepinephrine and dopamine reuptake inhibition, which differs from SSRIs:

• Brain imaging studies show bupropion increases activity in regions associated with sexual motivation and arousal, including the posterior midcingulate cortex, mediodorsal thalamus, and extended amygdala 8
• The typical starting dose is 37.5-75mg daily, increasing to 150mg daily or twice daily as tolerated 7, 5
• For SSRI-induced sexual dysfunction, bupropion can be used as needed (75-150mg taken 1-2 hours before sexual activity) or as a scheduled daily medication 4

Important Safety Considerations

Bupropion has specific contraindications and side effects to monitor:

• Should not be used in patients with seizure disorders or eating disorders due to increased seizure risk 7, 1
• May cause anxiety, tremor, or insomnia; giving the second dose before 3 PM can minimize sleep disturbance 7
• Anxiety and tremor led to discontinuation in 15% of patients in one study 4
• Tends to be activating rather than sedating, which can be beneficial for energy and libido but problematic in agitated patients 7

No Evidence for Vraylar (Cariprazine) in Sexual Function

There is no evidence that Vraylar enhances sexual function or provides additive benefit when combined with bupropion:

• Vraylar is an atypical antipsychotic indicated for schizophrenia, bipolar disorder, and major depressive disorder as adjunctive therapy
• Antipsychotic medications, including Vraylar, can potentially cause or worsen sexual dysfunction through dopamine blockade and prolactin elevation
• The combination should only be used if there is a clear psychiatric indication for Vraylar independent of sexual function concerns

Clinical Approach

For patients seeking treatment for low libido or sexual dysfunction:

1. First, identify and address contributing factors: medications (especially SSRIs, beta-blockers), medical conditions (cardiovascular disease, diabetes), psychological factors (depression, anxiety, relationship issues), and menopausal symptoms 6

2. Consider bupropion 150mg daily as a treatment option for improving sexual desire and function, particularly if the patient is not on other antidepressants or has SSRI-induced sexual dysfunction 1, 2, 3

3. Monitor for response within 2-4 weeks and assess for side effects including anxiety, tremor, and insomnia 7, 4

4. Combine with non-pharmacological approaches including pelvic physical therapy, cognitive behavioral therapy, vaginal moisturizers/lubricants (if applicable), and lifestyle modifications 6

5. Do not add or continue Vraylar specifically for sexual enhancement, as there is no evidence supporting this use and it may worsen sexual function

Common Pitfalls to Avoid

• Expecting immediate results: bupropion may take 2-4 weeks to show full effects on sexual function 7
• Using bupropion in patients with seizure disorders or eating disorders 7, 1
• Combining with Vraylar expecting sexual enhancement when Vraylar may actually impair sexual function through its antipsychotic mechanism
• Ignoring underlying relationship, psychological, or medical factors that contribute to sexual dysfunction 6