Major
Bupropion × Sertraline
Other antidepressants (NDRI)×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Additive seizure threshold reduction. Sertraline is a weak CYP2D6 inhibitor with minimal effect on bupropion. Real risk is limited to patients with risk factors (prior epilepsy, eating disorders).
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 widely used for augmentation. Without risk factors, no special measures are needed. Standard doses. 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.