Major
Bupropion × Prednisolone
Other antidepressants (NDRI)×Glucocorticoids
Mechanism
Prednisolone (a systemic glucocorticoid) modestly lowers the seizure threshold; bupropion also lowers it. The effect is clinically significant during prolonged high-dose prednisolone, especially with prior epilepsy.
Symptoms
Seizures (generalised tonic-clonic or focal). Agitation, anxiety, insomnia from both drugs are possible.
Management
Avoid the combination in patients with prior epilepsy. If unavoidable, do not increase bupropion dose and use prednisolone at the minimum effective dose. Alternative antidepressants without seizure threshold reduction: sertraline, escitalopram.
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.