MajorOther antidepressants (NDRI)×Selective serotonin reuptake inhibitors (SSRIs)
Updated · Methodology
Mechanism
Escitalopram is a citalopram enantiomer with the same effects. Additive seizure threshold reduction (bupropion + escitalopram). High-dose escitalopram prolongs QT.
Symptoms
Seizures (especially with prior epilepsy or eating disorders), QT prolongation on ECG, dizziness.
Management
The combination is used to augment antidepressant response, but bupropion is contraindicated in patients with a seizure history per the label. Start bupropion at a low dose and titrate gradually. Start escitalopram at the low end of its dose range when bupropion is already on board, and if bupropion is added to an established escitalopram regimen, consider reducing the escitalopram dose. When bupropion is prescribed for smoking cessation in a patient taking an antidepressant, the label advises a maximum of 150 mg a day. Watch for agitation, tremor, myoclonus and fever (serotonin syndrome) during the first weeks and after dose increases.
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 Zyntabac 150 mg comprimidos de liberación prolongada (bupropión) (2024)– AEMPS, CIMA, nº registro 63265, revisión 03/2024, sección 4.4
- AEMPS: Ficha técnica Elontril 150 mg comprimidos de liberación modificada (bupropión) (2024)– AEMPS, CIMA, nº registro 68615, revisión 06/2024, secciones 4.3, 4.4 y 4.5
- AEMPS: Ficha técnica Cipralex 10 mg comprimidos (escitalopram) (2024)– AEMPS, CIMA, nº registro 65230, revisión 11/2024, sección 4.5
- FDA: Wellbutrin XL (bupropion hydrochloride extended-release) – Prescribing Information (2026)– FDA, DailyMed SPL, Bausch Health US, разделы 7.2, 7.3 и 12.3