Concurrent Use of Bupropion and Modafinil

Introduction to Medications

Bupropion is a dopamine/norepinephrine reuptake inhibitor approved for depression and smoking cessation, as noted by the American Gastroenterological Association 1
Modafinil is a wakefulness-promoting agent approved for excessive daytime sleepiness associated with narcolepsy, obstructive sleep apnea, and shift-work sleep disorder, according to the American Academy of Sleep Medicine 2

The combination of bupropion and modafinil may increase the risk of seizures, as bupropion is known to lower the seizure threshold, with case reports of seizures in breastfed infants exposed to bupropion, as reported by the American College of Obstetricians and Gynecologists 3, 4
Both medications can potentially increase blood pressure and heart rate, as indicated by the American Heart Association 1, 2
Overlapping side effects of bupropion and modafinil include insomnia and sleep disturbances, headache, nervousness, and anxiety, as noted by the National Sleep Foundation 2

The maximum daily dose of modafinil is 400 mg, typically administered as a single morning dose or divided into two doses, as recommended by the American Academy of Sleep Medicine 2
The maintenance dose of bupropion SR is typically 100-150 mg twice daily, with a maximum of 450 mg per day, as indicated by the American Psychiatric Association 3
If the combination is deemed necessary, consider starting with lower doses of both medications and monitoring closely, as suggested by the American Medical Association 2

Monitor for seizure activity or lowered seizure threshold, as recommended by the American Epilepsy Society 3, 4
Monitor for blood pressure and heart rate changes, as indicated by the American Heart Association 1, 2
Monitor for sleep disturbances, as noted by the National Sleep Foundation 2

In pregnancy, both medications have limited data, with bupropion showing possible risk for cardiovascular malformations, as reported by the American College of Obstetricians and Gynecologists 3, 4
In elderly patients, start with lower doses, particularly modafinil (100 mg), as recommended by the American Geriatrics Society 2