Wellbutrin and Celebrex: Auditory Hallucinations Risk
Wellbutrin (bupropion) can cause auditory hallucinations and psychosis as a known neuropsychiatric adverse effect, while Celebrex (celecoxib) is not associated with causing patients to hear voices. The combination of these medications does not have documented evidence of synergistic effects leading to auditory hallucinations.
Bupropion's Neuropsychiatric Effects
Bupropion carries significant risk for neuropsychiatric symptoms including psychosis, hallucinations, and precipitation of mania, particularly at higher doses. 1
- The medication is contraindicated in patients with seizure disorders and requires extreme caution when combined with antipsychotics due to lowered seizure threshold 2
- Depression and precipitation of mania are documented serious adverse effects of naltrexone/bupropion combinations 1
- When combined with risperidone (an antipsychotic), extreme caution is required due to seizure risk amplification 2
Celecoxib's Safety Profile
Celebrex (celecoxib) does not have documented associations with auditory hallucinations or psychotic symptoms. 1
- The primary safety concerns with celecoxib involve cardiovascular thrombotic events, myocardial infarction, stroke, and gastrointestinal complications 1
- Black box warnings for celecoxib focus exclusively on cardiovascular and gastrointestinal risks, with no mention of neuropsychiatric effects 1
Clinical Assessment Approach
If a patient on this combination reports hearing voices, immediately evaluate:
- Bupropion dosing: Confirm the patient is not exceeding 360 mg daily (maximum dose for naltrexone/bupropion combination) 1
- Seizure history: Verify no personal history of seizures, brain lesions, or conditions lowering seizure threshold 2
- Concurrent medications: Check for other serotonergic or dopaminergic agents that could contribute to neuropsychiatric symptoms 2
- Substance use: Rule out methamphetamine or cocaine use, which can cause similar symptoms 1
Management Recommendations
Discontinue bupropion immediately if auditory hallucinations develop, as this represents a serious neuropsychiatric adverse effect requiring medication cessation. 1
- Celecoxib can be safely continued if needed for pain management, as it is not implicated in the psychiatric symptoms 1
- Consider alternative antidepressants without psychosis risk, though SSRIs have their own neonatal and withdrawal considerations 1
- Monitor for resolution of symptoms within days to weeks after bupropion discontinuation 1
Important Caveats
- Bupropion's risk of neuropsychiatric effects increases with dose escalation and in patients with underlying psychiatric conditions 1, 2
- The combination with any medication affecting dopamine or serotonin systems amplifies risk 2
- Patients with uncontrolled hypertension should not receive bupropion regardless of psychiatric symptoms 2