Is It Safe To Take Wellbutrin And Flexeril Together?
In our latest question and answer, the pharmacist discusses the interaction between Wellbutrin and Flexeril.
I take Wellbutrin (Bupropion HCl) as an antidepressant and was just prescribed cyclobenzaprine 5mg for muscle spasms. Is it ok to take these two together?
Sep 08, 2022- Both Wellbutrin and Flexeril can lower seizure threshold, so combining them increases seizure risk, especially if you have a history of seizures or other risk factors.
- These medications have been used together safely for short periods at standard doses in people without seizure risk factors, but safer muscle relaxant alternatives like methocarbamol exist.
- Talk to your doctor about whether this combination is appropriate for your situation or if a different muscle relaxant would be better.
Answer
Thanks for your question! There is a potential interaction between Flexeril (cyclobenzaprine) and Wellbutrin (bupropion).
Both are associated with increasing the risk of seizures (specifically, lowering the 'seizure threshold').
Although these drugs have been taken together safely for short periods of time, it is important to know of this potential interaction and they shouldn't be combined if you have a history of seizures, have risk factors for seizures, or are taking additional drugs that increase this risk further.
Wellbutrin And Flexeril Seizure Risk
Both Wellbutrin and Flexeril are associated with increasing the risk of seizures, although to a relatively small degree.
Wellbutrin, on its own, has been reported to cause seizures in about 0.4% of individuals taking the drug and it's been noted that the risk is dose-dependent (i.e. the higher the dose you take, the greater the risk).
Flexeril has also been associated with a seizure risk, but the risk appears to be quite low. In fact, several studies that have reviewed case studies of Flexeril overdoses report that only rarely have seizures been noted as a symptom that occurred. One such study reported the following:
Cyclobenzaprine overdoses were not reported to cause widened QRS, ventricular dysrhythmias, or seizures, and hypotension was rarely reported.
It seems most of the association between Flexeril and seizures comes from the fact the drug is closely related to a class of drugs (tricyclic antidepressants) that have a known risk of seizures and that seizures have been seen specifically between Flexeril and a drug called tramadol (this is noted in the prescribing information for Flexeril).
It's almost impossible to say definitively how risky it is to combine Wellbutrin and Flexeril. Since seizures have been reported with both drugs (more definitively with Wellbutrin), any 'drug interaction checker' you find online will likely show some sort of result for these two drugs.
Alternative Options
As mentioned, Flexeril and Wellbutrin have been used together safely, for short periods of time. It is very unlikely that individuals taking Wellbutrin and Flexeril, for short periods of time, at FDA-approved doses, without additional risk factors (such as old age, alcohol use, liver dysfunction, etc...) will have a problem.
Having said this, there are some safer options in regard to muscle relaxants that aren't associated with increasing the risk of seizures, like methocarbamol and orphenadrine. Be sure to talk to your doctor about your options and what makes the most sense for your clinical situation.
Final Words
Thanks again for reaching out and I hope this answer was helpful!
References & sources
- Wellbutrin Prescribing Information — AccessFDA
- Serotonin syndrome from the interaction of cyclobenzaprine with other serotoninergic drugs — PubMed
- Flexeril Prescribing Information — AccessFDA
- Robaxin Prescribing Information — AccessFDA
- Cyclobenazpine Monograph — PubChem
- Considerations for the Appropriate Use of Skeletal Muscle Relaxants for the Management Of Acute Low Back Pain — PubMed
- Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose — PubMed
Glossary — Terms in This Answer
- Cyclobenzaprine
- The generic name for the muscle relaxant medication sold under the brand name Flexeril.
- Bupropion
- The generic name for the antidepressant medication sold under the brand name Wellbutrin.
- Seizure threshold
- The level at which the brain is likely to experience a seizure; lowering this threshold means seizures are more likely to occur.
- Dose-dependent
- A relationship where the effect of a medication increases or decreases based on how much of the drug is taken.
- Tricyclic antidepressants
- A class of older antidepressant medications that work by affecting certain brain chemicals.
- Ventricular dysrhythmias
- Abnormal heart rhythms occurring in the heart's lower chambers.
- Methocarbamol
- An alternative muscle relaxant medication that does not have an associated risk of lowering seizure threshold.
- Orphenadrine
- Another alternative muscle relaxant medication that does not have an associated risk of lowering seizure threshold.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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