From the FDA Drug Label
WARNINGS Serious Cardiovascular Events Sudden Death in Patients with Pre-existing Structural Cardiac Abnormalities or Other Serious Heart Problems: Children and Adolescents Sudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems Although some serious heart problems alone carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug Adults Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems.
(n=114) (General) iting 2% 4% 2% Dysphagia 0% 0% 2% Musculoskeletal Myalgia 3% 2% 6% Arthralgia 1% 1% 4% Arthritis 0% 0% 2% Twitch - 1% 2% Nervous System Insomnia 6% 11% 16% Dizziness 5% 7% 11% Agitation 2% 3% 9% Anxiety 3% 5% 6% Tremor 1% 6% 3% Nervousness 3% 5% 3% Somnolence 2% 2% 3% Irritability 2% 3% 2% Memory decreased 1% - 3% Paresthesia 1% 1% 2% Central nervous system stimulation 1% 2% 1%
The concerns about being on Adderall (amphetamine), Wellbutrin (bupropion), and fluoxetine include:
- Cardiovascular risks: Sudden death, stroke, and myocardial infarction have been reported in adults taking stimulant drugs, such as Adderall, at usual doses for ADHD.
- Psychiatric adverse events: Adderall may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder. Wellbutrin may cause insomnia, anxiety, agitation, and irritability.
- Interactions: The combination of these medications may increase the risk of adverse events, such as serotonin syndrome, due to the potential for increased serotonin levels.
- Monitoring: Patients should be monitored for changes in heart rate, blood pressure, and psychiatric symptoms while taking these medications.
- Contraindications: Adderall is contraindicated in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems. Wellbutrin is contraindicated in patients with a seizure disorder or eating disorder. 1 2
From the Research
Taking Adderall (amphetamine), Wellbutrin (bupropion), and fluoxetine (Prozac) together is not recommended due to the high risk of serotonin syndrome, a potentially life-threatening condition, as evidenced by a case report of serotonin syndrome induced by a combination of bupropion and SSRIs 3. The main concerns with this combination include:
- Increased risk of serotonin syndrome, as both fluoxetine and Wellbutrin can increase serotonin levels, while Adderall can enhance this effect
- Significantly increased risk of seizures, as both Wellbutrin and Adderall lower the seizure threshold
- Cardiovascular effects, such as increased blood pressure and heart rate, potentially leading to hypertension, arrhythmias, or other cardiac complications
- Worsening of anxiety, insomnia, and agitation due to the stimulating properties of all three medications
- Potential for decreased appetite and weight loss, as well as increased risk of dry mouth, constipation, and urinary retention due to anticholinergic effects A more recent study 4 highlights the risk of combining antidepressants with β-blockers, which may be relevant to patients taking Adderall, Wellbutrin, and fluoxetine, as it suggests that initiating an antidepressant in patients receiving β-blockers can increase the risk of hemodynamic adverse events. It is essential for anyone prescribed this combination to be closely monitored by their healthcare provider, with regular blood pressure checks, heart rate monitoring, and assessment for signs of serotonin syndrome, such as confusion, rapid heart rate, dilated pupils, muscle rigidity, and high fever 5. Any unusual symptoms should be reported immediately to a healthcare provider. Additionally, a study on delayed serotonin syndrome 6 emphasizes the importance of considering this condition even in cases where the onset of symptoms may be delayed, and another study on the use of bupropion in combination with serotonin reuptake inhibitors 7 highlights the need for careful consideration of potential interactions and side effects when combining these medications.