Prozac Wellbutrin Interaction – Case Scenario

Here’s a case scenario involving the Prozac Wellbutrin interaction. A 64 year old male has severe depression.  He is currently on Remeron 15 mg once daily, Prozac 80 mg once daily, and Abilify 10 mg once daily.  He has been tried on just about every other SSRI and SNRI without any benefit.  He is still reporting that he would like something in addition to his current regimen.

Abilify was tried at a higher dose, but the patient experienced troublesome tremors and other extrapyramidal symptoms.  Remeron was also tried at higher does and the patient reported that he had nightmares and abnormal dreams on the 30 mg dose.  Tri-cyclic antidepressants have also been tried in the past with no benefit.  The patient cannot recall if he has been on Wellbutrin and the psychiatrist working with him did not see any contraindications to adding it.

A prescription is written for Wellbutrin XL 150 mg once daily for 7 days and increase to 300 mg once daily after that.

At about week 2, the patient is reporting significant anxiety and insomnia.  Upon assessment, he is also having some tachycardia and has a slightly elevated temperature. He believes that it is likely from the addition of the Wellbutrin.  The patient is likely correct in the situation in that these are probably side effects of medication, but you certainly could make an argument that the side effects may be from the Prozac.

The Prozac Wellbutrin interaction is one to put in your storage bank.  Wellbutrin is an inhibitor of CYP2D6 and could potentially lead to increased concentrations of Prozac.  If we did a little deeper and look at this from a clinical perspective, the patient may be beginning to display mild signs and symptoms of serotonin syndrome.

I see situations similar to this when it comes to drug interactions and often times what puts some patients over the top and into the danger zone is the dosing of the medication.  This particular patient was already on a high dose of the Prozac and the Wellbutrin was escalated to a decent dose as well.  Having a patient on this high of a dose of Prozac probably enhanced the concentrations of the drug dramatically.  When assessing interactions like this, (hopefully prior to initiating medication), you have got to look at the relative doses and consider them prior to starting therapy.

In this Prozac Wellbutrin interaction scenario, the very high dose of dose of Prozac probably led to this interaction being a very significant one for the patient.

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  1. Jennifer Lowe

    I believe this would be a Wellbutrin and abilify interaction moreso than Prozac

  2. Felipe Lopez-Ocampo

    Good one!

  3. Jennifer Obenrader, PharmD, CDE

    Pharmacogenomic Testing also could reveal the correct medications for this gentleman, since he has tried and failed so many regimens.

  4. Bob Coolidge

    We’re you able to submit a fee to insurance or to the patient for your consult?

    • Eric Christianson

      Unfortunately not in this scenario Bob – thanks for reaching out! Eric

  5. Thomas Leslie

    I am on Hcl sr 200 Mg 2times a day and they put me on Prozac with They’re out and about three days later after taking the Prozac I had a seizure I was going up my stairs and I fell down like 15 instead I’m guessing and had to Call ambulance it was very serious in hospital. Well the doctor told me that it would probably was interacting which she probably wouldn’t have met right now but I don’t think that it’s right it could’ve killed me

  6. Mariana Ivanylo, PharmD

    I would also consider performing a pharmacogenomic test on CYP 2D6 genotype in this patient. Because this enzyme’s gene commonly exhibits polymorphism. It’s possible this patient is poor metabolizer of Prozac, leading to higher blood levels and increased adverse effects when Wellbutrin was added to the regimen.


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Written By Eric Christianson

May 27, 2018

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