MajorOther antidepressants (NDRI)×SSRI (selective serotonin reuptake inhibitor)
Updated · Methodology
Mechanism
Additive seizure threshold reduction (both drugs do this). Weak additional serotonergic risk (bupropion has minimal serotonergic activity). Citalopram itself prolongs QT.
Symptoms
Seizures (especially with prior epilepsy or eating disorders), QT prolongation on ECG, dizziness. Serotonin syndrome when other serotonergics are added.
Management
Start bupropion at a low dose and increase it gradually (FDA label). Bupropion raises citalopram exposure: AUC by 40% and Cmax by 30%. So when bupropion is added to citalopram, the Spanish bupropion SmPC calls for reviewing whether the citalopram dose should be lowered. If bupropion is prescribed for smoking cessation to someone taking an antidepressant, the Zyntabac SmPC advises considering a ceiling of 150 mg/day. Bupropion is contraindicated with a history of seizures, bulimia or anorexia nervosa.
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Wellbutrin (bupropion hydrochloride) prescribing information (2017)– ; DailyMed setid cbc8c074-f080-4489-a5ae-207b5fadeba3
- AEMPS: Ficha técnica de Zyntabac 150 mg comprimidos de liberación prolongada (bupropión) (2024)– AEMPS CIMA, nregistro 63265, secciones 4.4, 4.5
- AEMPS: Ficha técnica de Elontril 150 mg comprimidos de liberación modificada (bupropión) (2024)– AEMPS CIMA, nregistro 68615, secciones 4.3, 4.4, 4.5
- FDA: Wellbutrin XL (bupropion hydrochloride extended-release) prescribing information (2026)– FDA label, DailyMed setid a435da9d-f6e8-4ddc-897d-8cd2bf777b21, sections 5.3, 7.2, 7.3, 12.3
- AEMPS: Ficha técnica de Citalopram Bexal 30 mg comprimidos (2023)– AEMPS CIMA, nregistro 65994, secciones 4.5