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Drug Interactions between Seroquel XR and Wellbutrin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

buPROPion QUEtiapine

Applies to: Wellbutrin (bupropion) and Seroquel XR (quetiapine)

MONITOR CLOSELY: The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, or any substance that can reduce the seizure threshold (e.g., carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, theophylline). These agents are often individually epileptogenic and may have additive effects when combined. The estimated incidence of seizures is approximately 0.4% for immediate-release bupropion hydrochloride at dosages between 300 to 450 mg/day (equivalent to 348 to 522 mg/day of bupropion hydrobromide), but increases almost tenfold between 450 mg and 600 mg/day (equivalent to 522 and 696 mg/day of bupropion hydrobromide). Data for sustained-release (SR) bupropion hydrochloride revealed a seizure incidence of approximately 0.1% at dosages up to 300 mg/day and 0.4% at 400 mg/day. Likewise, in clinical trials, an overall seizure incidence of approximately 0.1% has been reported with extended-release (XL) bupropion hydrochloride at dosages up to 450 mg/day and approximately 0.39% at 450 mg/day. The 0.4% seizure incidence may exceed that of other marketed antidepressants by as much as 4-fold.

MANAGEMENT: Extreme caution is advised if bupropion is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with a history of seizures or other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Bupropion as well as concomitant medications should be initiated at the lower end of the dosage range and titrated gradually as needed and as tolerated. The maximum recommended dosage for the specific bupropion formulation should not be exceeded. Bupropion should be discontinued and not restarted in patients who experience a seizure during treatment.

References

  1. Rosenstein DL, Nelson JC, Jacobs SC "Seizures associated with antidepressants: a review." J Clin Psychiatry 54 (1993): 289-99
  2. James WA, Lippmann S "Bupropion: overview and prescribing guidelines in depression." South Med J 84 (1991): 222-4
  3. Johnston JA, Lineberry CG, Ascher JA, et al. "A 102-center prospective study of seizure in association with bupropion." J Clin Psychiatry 52 (1991): 450-6
  4. Gittelman DK, Kirby MG "A seizure following bupropion overdose." J Clin Psychiatry 54 (1993): 162
  5. Sheehan DV, Welch JB, Fishman SM "A case of bupropion-induced seizure." J Nerv Ment Dis 174 (1986): 496-8
  6. Dufresne RL, Weber SS, Becker RE "Bupropion hydrochloride." Drug Intell Clin Pharm 18 (1984): 957-64
  7. "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome PROD (2001):
  8. Masco HL, Kiev A, Holloman LC, Batey SR, Johnston JA, Lineberry CG "Safety and efficacy of bupropion and nortriptyline in outpatients with depression." Curr Ther Res Clin Exp 55 (1994): 851-63
  9. Storrow AB "Bupropion overdose and seizure." Am J Emerg Med 12 (1994): 183-4
  10. "Product Information. Wellbutrin SR (bupropion)." Glaxo Wellcome PROD (2001):
  11. "Product Information. Zyban (bupropion)." Glaxo Wellcome PROD (2001):
  12. Pisani F, Spina E, Oteri G "Antidepressant drugs and seizure susceptibility: from in vitro data to clinical practice." Epilepsia 40(Suppl 10) (1999): S48-56
  13. "Product Information. Wellbutrin XL (bupropion)." GlaxoSmithKline (2003):
  14. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  15. "Product Information. Aplenzin (bupropion)." sanofi-aventis (2009):
View all 15 references

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Drug and food interactions

Moderate

buPROPion food

Applies to: Wellbutrin (bupropion)

GENERALLY AVOID: Excessive use or abrupt discontinuation of alcohol after chronic ingestion may precipitate seizures in patients receiving bupropion. Additionally, there have been rare postmarketing reports of adverse neuropsychiatric events or reduced alcohol tolerance in patients who drank alcohol during treatment with bupropion. According to one forensic report, a patient died after taking large doses of both bupropion and alcohol. It is uncertain whether a drug interaction was involved. Single-dose studies in healthy volunteers given bupropion and alcohol failed to demonstrate either a significant pharmacokinetic or pharmacodynamic interaction.

MANAGEMENT: The manufacturer recommends that alcohol consumption be minimized or avoided during bupropion treatment. The use of bupropion is contraindicated in patients undergoing abrupt discontinuation of alcohol.

References

  1. Posner J, Bye A, Jeal S, Peck AW, Whiteman P "Alcohol and bupropion pharmacokinetics in healthy male volunteers." Eur J Clin Pharmacol 26 (1984): 627-30
  2. Ramcharitar V, Levine BS, Goldberger BA, Caplan YH "Bupropion and alcohol fatal intoxication: case report." Forensic Sci Int 56 (1992): 151-6
  3. Hamilton MJ, Bush MS, Peck AW "The effect of bupropion, a new antidepressant drug, and alcohol and their interaction in man." Eur J Clin Pharmacol 27 (1984): 75-80
  4. "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome PROD (2001):
View all 4 references

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Moderate

buPROPion food

Applies to: Wellbutrin (bupropion)

MONITOR: Additive or synergistic effects on blood pressure may occur when bupropion is combined with sympathomimetic agents such as nasal decongestants, adrenergic bronchodilators, ophthalmic vasoconstrictors, and systemic vasopressors. Treatment with bupropion can result in elevated blood pressure and hypertension. In clinical practice, hypertension, in some cases severe and requiring acute treatment, has been observed in patients receiving bupropion alone and in combination with nicotine replacement therapy. These events have occurred in both patients with and without evidence of preexisting hypertension. Furthermore, postmarketing cases of hypertensive crisis have been reported during the initial titration phase with bupropion-naltrexone treatment.

MANAGEMENT: Caution is advised when bupropion is used with other drugs that increase dopaminergic or noradrenergic activity due to an increased risk of hypertension. Blood pressure and heart rate should be measured prior to initiating bupropion therapy and monitored at regular intervals consistent with usual clinical practice, particularly in patients with preexisting hypertension. Dose reduction or discontinuation of bupropion should be considered in patients who experience clinically significant and sustained increases in blood pressure or heart rate.

References

  1. "Product Information. Auvelity (bupropion-dextromethorphan)." Axsome Therapeutics, Inc. 1 (2022):
  2. "Product Information. Zyban (bupropion)." GlaxoSmithKline UK Ltd (2022):
  3. "Product Information. Wellbutrin XL (bupropion)." Bausch Health, Canada Inc. (2022):
  4. "Product Information. Contrave (bupropion-naltrexone)." Currax Pharmaceuticals LLC (2021):
View all 4 references

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Moderate

buPROPion food

Applies to: Wellbutrin (bupropion)

MONITOR: The concomitant use of bupropion and nicotine replacement for smoking cessation may increase the risk of hypertension. In a clinical study (n=250), 6.1% of patients who used sustained-release bupropion with nicotine transdermal system developed treatment-emergent hypertension, compared to 2.5% of patients treated with bupropion alone, 1.6% treated with nicotine alone, and 3.1% treated with placebo. Three patients in the bupropion plus nicotine group and one patient in the nicotine-only group discontinued treatment due to hypertension. The majority had evidence of preexisting hypertension.

MANAGEMENT: Blood pressure monitoring is recommended for patients concomitantly using bupropion and nicotine replacement for smoking cessation.

References

  1. "Product Information. Zyban (bupropion)." Glaxo Wellcome PROD (2001):

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.