Are there interactions between hydroxychloroquine and the following medications: Wellbutrin (bupropion), escitalopram, Adderall, Mounjaro (tirzepatide), Ubrelvy (ubrogepant)?

Drug Interactions Between Hydroxychloroquine and Your Medications

Direct Answer

Yes, hydroxychloroquine has clinically significant interactions with escitalopram and potentially with bupropion (Wellbutrin), requiring cardiac monitoring and caution, while interactions with Adderall, Mounjaro, and Ubrelvy are less concerning but warrant awareness. 1

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Critical Cardiac Interaction: Escitalopram

Escitalopram is contraindicated or requires extreme caution when combined with hydroxychloroquine due to additive QT interval prolongation that can cause fatal cardiac arrhythmias (torsades de pointes). 1

• The American College of Cardiology and American Heart Association specifically identify citalopram and escitalopram as contraindicated with hydroxychloroquine due to severe torsades de pointes risk 2, 1
• Both drugs independently prolong the QT interval on ECG, and when combined, create an additive risk for sudden cardiac death 2, 1
• If you must continue both medications, you require baseline ECG monitoring, regular follow-up ECGs, and strict electrolyte monitoring (particularly potassium levels) 2, 1
• Withhold hydroxychloroquine if your QTc interval exceeds 500 ms or increases by ≥60 ms from baseline 2

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Moderate Interaction: Bupropion (Wellbutrin)

Bupropion has a potential pharmacokinetic interaction with hydroxychloroquine through the CYP2D6 enzyme pathway, though this is less severe than the cardiac risk with escitalopram. 3, 4

• Hydroxychloroquine is a weak CYP2D6 inhibitor, and bupropion is metabolized by CYP2D6 3
• This interaction could theoretically increase bupropion levels, potentially increasing seizure risk (bupropion's dose-dependent side effect) 3, 4
• Monitor for increased bupropion side effects including agitation, insomnia, tremor, or seizures 4
• Unlike escitalopram, bupropion does not significantly prolong QT interval, making this a safer antidepressant option with hydroxychloroquine 1

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Lower-Risk Interactions: Adderall, Mounjaro, Ubrelvy

Adderall (amphetamine/dextroamphetamine):

• No direct pharmacokinetic interaction documented 4
• Theoretical concern: both drugs can affect cardiac conduction, though Adderall's primary risk is tachycardia rather than QT prolongation 2
• Monitor heart rate and blood pressure, but no specific contraindication exists 2

Mounjaro (tirzepatide):

• No documented interaction between hydroxychloroquine and GLP-1 receptor agonists 4
• Both can cause gastrointestinal side effects (nausea, vomiting, diarrhea), which could lead to electrolyte disturbances that increase cardiac risk 5
• Ensure adequate hydration and monitor electrolytes if experiencing GI symptoms 2, 5

Ubrelvy (ubrogepant):

• No documented interaction with hydroxychloroquine 4
• Ubrogepant is metabolized primarily by CYP3A4, and hydroxychloroquine has minimal effect on this pathway 3, 4

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Essential Monitoring Requirements

If continuing hydroxychloroquine with escitalopram (against recommendation) or with multiple medications:

• Obtain baseline 12-lead ECG before starting or continuing the combination 2
• Repeat ECG after 2 doses to identify "QTc reactors" (patients with exaggerated QT response) 2
• Check and maintain normal potassium and magnesium levels—hypokalemia dramatically increases arrhythmia risk 2, 1
• Monitor for cardiac symptoms: palpitations, lightheadedness, syncope 2
• Consider twice-daily QTc monitoring if QTc is 500-550 ms 2

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Common Pitfalls to Avoid

• Do not assume all antidepressants carry equal risk—escitalopram is specifically contraindicated while sertraline or bupropion are safer alternatives 1
• Do not overlook over-the-counter medications that prolong QT interval (antihistamines like diphenhydramine, certain supplements) 1
• Do not ignore gastrointestinal symptoms—nausea, vomiting, and diarrhea from either hydroxychloroquine or Mounjaro can cause electrolyte disturbances that amplify cardiac risk 5
• Check for other QT-prolonging medications you may be taking (ondansetron, domperidone, certain antibiotics) 1

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Risk Factors That Increase Danger

Your risk is higher if you have: 2, 6

• Age >65 years
• Pre-existing heart disease or heart failure
• Diabetes (which you may have if taking Mounjaro)
• Renal insufficiency
• Female sex
• Fever or active inflammatory state
• Concurrent use of diuretics or corticosteroids (which lower potassium)

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Safest Approach

The safest strategy is to switch from escitalopram to an alternative antidepressant with lower QT prolongation risk (such as sertraline) before continuing hydroxychloroquine. 1 If both medications are deemed absolutely necessary, implement rigorous cardiac monitoring with serial ECGs and electrolyte checks, and be prepared to discontinue one or both drugs if QTc exceeds 500 ms. 2, 1