Major
Bupropion × Fluoxetine
Other antidepressants (NDRI)×Selective serotonin reuptake inhibitors
Mechanism
Fluoxetine is a potent CYP2D6 inhibitor. Levels of bupropion's active metabolite (hydroxybupropion) rise. Both drugs lower the seizure threshold.
Symptoms
Seizures (generalised tonic-clonic or focal), agitation, tremor, insomnia. Patients with prior epilepsy or eating disorders are at particular risk.
Management
The combination is possible for augmentation with careful monitoring. Keep doses low: fluoxetine 20 mg, bupropion 300 mg/day. Avoid with prior epilepsy or eating disorders.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.