[Uncreate]

I take Adderall XR 60mg, Lamictal 400mg, Wellbutrin XL 450mg. I weigh 260 at 6'6". Does anyone know of any drug interactions with these? I want make sure everything is safe. BTW the Adderall doesn't give me panic attacks.

[null0trooper]

Uncreate, on Mar 25 2008, 04:10 PM, said:

I take Adderall XR 60mg, Lamictal 400mg, Wellbutrin XL 450mg. I weigh 260 at 6'6". Does anyone know of any drug interactions with these? I want make sure everything is safe. BTW the Adderall doesn't give me panic attacks.

Lamictal is an anticonvulsant, so that should reduce the seizure risk associated with Wellbutrin. Adderall and Wellbutrin are a somewhat synergistic combination - Adderall causes release of noradrenaline and dopamine, while Wellbutrin inhibits reuptake of noradrenaline and, to a much lesser extent, dopamine.

amphetamine's cleared by the kidneys, while bupropion and lamotrigine are metabolized extensively in the liver by differing pathways.

So nothing really leaps out, but you'll want to keep an eye on your blood pressure, heartrate, hydration ... the usual stuff for a stimulant/adrenergic combination.

[Uncreate]

Thanks... it's a relief that some people agree with me. One of my friends made me almost flip out saying that Adderall + Lamictal was bad. I didn't believe it, but I enjoy reassurance.

[beetle]

null0trooper, on Mar 25 2008, 07:46 PM, said:

Uncreate, on Mar 25 2008, 04:10 PM, said:

I take Adderall XR 60mg, Lamictal 400mg, Wellbutrin XL 450mg. I weigh 260 at 6'6". Does anyone know of any drug interactions with these? I want make sure everything is safe. BTW the Adderall doesn't give me panic attacks.

Lamictal is an anticonvulsant, so that should reduce the seizure risk associated with Wellbutrin. Adderall and Wellbutrin are a somewhat synergistic combination - Adderall causes release of noradrenaline and dopamine, while Wellbutrin inhibits reuptake of noradrenaline and, to a much lesser extent, dopamine.

amphetamine's cleared by the kidneys, while bupropion and lamotrigine are metabolized extensively in the liver by differing pathways.

So nothing really leaps out, but you'll want to keep an eye on your blood pressure, heartrate, hydration ... the usual stuff for a stimulant/adrenergic combination.

I thought it was the other way with Wellbutrin. Dopamine first, then norepinephrine.

[null0trooper]

Uncreate, on Mar 29 2008, 10:44 AM, said:

Thanks... it's a relief that some people agree with me. One of my friends made me almost flip out saying that Adderall + Lamictal was bad. I didn't believe it, but I enjoy reassurance.

From what I've read, stimulants can be a rotten combination with bipolar disorder, Tourette's, or a low seizure threshold. That could be what had your friend worried for you.

[null0trooper]

beetle, on Mar 29 2008, 11:13 AM, said:

I thought it was the other way with Wellbutrin. Dopamine first, then norepinephrine.

Definitely not.

From a PubMed abstract:

Quote

CONCLUSIONS: Bupropion treatment occupies less than 22% of DAT sites. This raises the question as to whether a DAT occupancy of less than 22% is therapeutic or whether there is another mechanism involved during treatment with bupropion.

One might get the impression that it's this wonderful dopaminergic AD from the studies looking only at the dopamine transporter - a priority in cocaine addiction research. However, bupropion and its metabolites make for a strong noradrenaline reuptake inhibitor, and is one of the few (only?) ADs which bind to nicotinic receptors (acetylcholine).

[null0trooper]

Guest_beetle_*, on Mar 29 2008, 03:16 PM, said:

Some references state it differently though.

http://en.wikipedia....anism_of_action

For many ADs, unless you have the time to review the references being abused and keep in mind the ones being skipped, Wikipedia can be a lousy reference. Wikipedia's reference [83] ( like Wikipedia itself ) involved no clinical research - instead it was a literature review that concluded "The preclinical and clinical data show that bupropion acts via dual inhibition of norepinephrine and dopamine reuptake and is devoid of clinically significant serotonergic effects or direct effects on postsynaptic receptors." In other words, the only AD mechanisms they recognized involved NET and/or DAT inhibition and no one's separated the two. (You probably can't - other research has found that dopamine is also transported by the noradrenaline transporter)

As to Table 1 in the Wikipedia article, none of the the five references cited support the presumption that "potency of DA uptake inhibition by bupropion = 100%" That's most likely someone doing a badly misleading job of normalization.

Anyway, as the metabolites ARE thought to dominate the mechanisms of action - having longer half-lives than the parent material, they would be the fraction that builds up to a therapeutic level over the course of time. So in practice bupropion is still primarily a noradrenergic med that has more dopaminergic effect that most other common ADs. I'll agree that unless one is overly sensitive to serotonin transmission, the SERT inhibition is negligible.