Major
Bupropion × fluvoxamine
Other antidepressants (NDRI)×SSRI
Mechanism
Fluvoxamine is a weak CYP2D6 inhibitor but a strong CYP2C19 and CYP1A2 inhibitor. Bupropion levels may rise. Both drugs lower the seizure threshold.
Symptoms
Seizures (especially with prior epilepsy or eating disorders), anxiety, insomnia. Agitation possible.
Management
The combination is possible for augmentation. Keep doses low: bupropion ≤300 mg, fluvoxamine ≤100 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.