MajorOther antidepressants (NDRI)×First-generation antipsychotics. Butyrophenone derivatives
Updated · Methodology
Mechanism
Haloperidol is a CYP2D6 substrate; bupropion is a potent CYP2D6 inhibitor. Haloperidol plasma levels rise 2- to 3-fold. Risk of extrapyramidal symptoms and QT prolongation emerges. Both drugs also lower the seizure threshold.
Symptoms
Extrapyramidal symptoms (tremor, rigidity, akathisia), QT prolongation on ECG, seizures. Older patients: fall risk.
Management
Avoid the combination. Alternative antipsychotics without CYP2D6 dependence: olanzapine or aripiprazole. Alternative antidepressants without CYP2D6 inhibition: 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.
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Sources
- FDA: Haloperidol tablet (Ajanta Pharma USA Inc.) – Prescribing Information (2008)– ; DailyMed setid 31e33656-2f53-49e6-9816-261ea2e6961a
- AEMPS: Ficha técnica: Haloperidol Esteve 2 mg/ml solución oral (nº registro 58355), secciones 4.4 y 4.5 (2020)– AEMPS, CIMA, nº registro 58355, revisión 07/2020, secciones 4.4 y 4.5