Can a patient with a history of seizures, eating disorders, or other conditions be on bupropion (Wellbutrin) and buspirone (Buspar) simultaneously?

Can You Be on Wellbutrin and Buspar Together?

Yes, bupropion (Wellbutrin) and buspirone (Buspar) can be used together in most patients, but this combination requires careful consideration of seizure risk, particularly when dose escalation occurs or when other seizure-lowering medications are present.

Key Considerations for Combined Use

Seizure Risk Assessment

The primary concern with bupropion is seizure risk, which must be evaluated before combining with any medication:

• Bupropion alone carries a seizure risk of 0.06-0.10% at therapeutic doses up to 300 mg/day in patients without predisposing factors 1
• The seizure rate with bupropion SR is within the range of other marketed antidepressants when used appropriately 1
• Absolute contraindications include current or past eating disorders, personal or family history of seizure disorders 1

Potential Drug Interaction Concerns

While the combination is generally feasible, there is documented evidence of interaction:

• A case report demonstrated acute dystonia (neck stiffness, trismus, TMJ subluxation) when bupropion SR was increased from 150 mg once daily to 150 mg twice daily while on buspirone 15 mg three times daily 2
• The dystonic reaction appeared to be dose-related to bupropion, with symptoms resolving when bupropion was reduced back to 150 mg once daily 2
• When buspirone was trialed alone at 45 mg/day, no dystonic symptoms occurred, suggesting bupropion was the primary culprit, possibly sensitized by the combination 2
• Both agents interact with dopaminergic and serotonergic systems, which may explain the observed reaction 2

Clinical Algorithm for Safe Coadministration

Step 1: Screen for Contraindications

• Rule out eating disorders (anorexia, bulimia)
• Rule out personal or family history of seizures
• Avoid combination with other seizure-threshold-lowering medications (particularly clozapine, which showed seizure risk when combined with bupropion) 3

Step 2: Dosing Strategy

• Start bupropion at lower doses (150 mg SR once daily) when combining with buspirone 2
• Titrate bupropion slowly, monitoring for dystonic symptoms (jaw tightness, neck stiffness, TMJ issues) within 24-48 hours of dose increases 2
• Keep total daily bupropion dose at or below 300 mg/day to minimize seizure risk 1

Step 3: Monitor for Specific Adverse Effects

• Watch for early dystonic reactions: jaw clenching, neck muscle spasm, TMJ subluxation, particularly within 24-48 hours of bupropion dose escalation 2
• Monitor for seizure warning signs, especially if other risk factors emerge
• If dystonic symptoms appear, reduce bupropion dose immediately 2

Important Caveats

The combination is used in clinical practice and can be effective, but dose-related adverse effects are possible. The single documented case of dystonia suggests that some patients may be particularly sensitive to this combination 2. The reaction was reversible and dose-dependent, indicating that lower bupropion doses may be better tolerated when combined with buspirone 2.

Bupropion has been successfully combined with other agents (such as dextromethorphan) for enhanced antidepressant effects 4, demonstrating that combination therapy with bupropion is a viable strategy when appropriately monitored.