Major
Bupropion × Quetiapine
Other antidepressants (NDRI)×Atypical antipsychotics
Mechanism
Quetiapine lowers the seizure threshold, especially at doses above 300 mg/day. Bupropion is a potent proconvulsant. Additive seizure risk.
Symptoms
Seizures (generalised tonic-clonic or focal), agitation, tremor, insomnia. Patients with prior epilepsy or eating disorders are at particular risk.
Management
Avoid the combination, especially with quetiapine above 300 mg. Alternative antipsychotics: olanzapine or aripiprazole (minimal seizure threshold effect). Alternative antidepressants: sertraline or 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.