Drug Interactions Between Lamotrigine, Bupropion, and Qulipta (Atogepant)
These medications can be safely used together without clinically significant interactions. Based on available evidence, there are no documented pharmacokinetic or pharmacodynamic interactions between lamotrigine, bupropion, and atogepant that would require dose adjustments or contraindicate their concurrent use.
Lamotrigine and Bupropion Combination
Bupropion does not affect lamotrigine levels and can be safely combined. A randomized crossover study in healthy subjects demonstrated that steady-state bupropion 150 mg twice daily caused no clinically relevant changes in the pharmacokinetics of lamotrigine 1. This combination is commonly used in clinical practice for patients with comorbid mood disorders and epilepsy 2.
Key Safety Considerations:
- No dose adjustment needed for either medication when used together 1
- Monitor for additive CNS effects (insomnia, agitation, anxiety) as both medications have stimulant properties 3
- Seizure risk remains a concern with bupropion, particularly at doses exceeding 450 mg/day, but lamotrigine does not increase this risk 3
- The combination has been studied and used safely in bipolar depression, where lamotrigine is frequently combined with antidepressants including bupropion 2
Atogepant (Qulipta) Interactions
Atogepant has no known interactions with lamotrigine or bupropion. The provided evidence does not document any interactions between atogepant and either lamotrigine or bupropion. Atogepant is a CGRP receptor antagonist used for migraine prevention and is not metabolized through the same pathways that would create interactions with these medications.
Important Caveats:
- Lamotrigine interactions primarily involve enzyme inducers (carbamazepine, phenytoin) that increase its clearance, or valproic acid which decreases its clearance 4, 5
- Bupropion's main interaction concerns relate to CYP2D6 inhibition and seizure threshold lowering, neither of which involve atogepant 3
- No hepatic enzyme induction or inhibition occurs with atogepant that would affect lamotrigine or bupropion metabolism
Clinical Monitoring Recommendations
When using this three-drug combination, monitor for:
- Cardiovascular effects: Both bupropion and potentially lamotrigine can affect heart rate and blood pressure; check baseline and periodic vital signs 3
- CNS stimulation: Watch for insomnia, anxiety, agitation, or appetite changes from bupropion 3
- Seizure activity: Maintain awareness that bupropion lowers seizure threshold, though lamotrigine provides anticonvulsant protection 6
- Lamotrigine therapeutic levels if seizure control changes, though routine monitoring is not required with this combination 4
Common Pitfalls to Avoid
- Do not confuse lamotrigine interactions with combined oral contraceptives (which significantly decrease lamotrigine levels) with other drug combinations 7
- Do not exceed bupropion 450 mg/day to minimize seizure risk, regardless of concomitant medications 3
- Do not assume atogepant interacts with anticonvulsants the way older migraine preventive medications (like topiramate) do 7
- Be aware that massive overdoses of lamotrigine and bupropion together can cause status epilepticus, though therapeutic dosing does not carry this risk 6