What Cold Medications Are Safe With Wellbutrin?
In our latest question and answer, our pharmacist discusses which over-the-counter cough/cold medications are safe to use with Wellbutrin (bupropion).
I am taking 75 mg of Wellbutrin every night and have been for 4-5 weeks. I recently came down with a pretty bad cold about 2 days ago and am looking for some relief. I understand that there are certain medications I cannot take while taking Wellbutrin (bupropion) and I was wondering if there are any cold medications that are safe to take. So far, I've been doing the homeopathic approach (steaming, lots of herbal tea, Chestal Honey for the cough, and Airborne).
Aug 29, 2022- Most over-the-counter cold medications like expectorants, antihistamines (except Benadryl), pain relievers, and nasal steroids are safe to use with Wellbutrin.
- Avoid Benadryl with Wellbutrin as it can increase in your body and cause side effects like drowsiness and dry mouth, but other antihistamines like Claritin and Zyrtec are fine.
- Be cautious with cough suppressants containing dextromethorphan and nasal decongestants, especially if you have a history of seizures, and talk to your doctor before using them.
Answer
Thanks for reaching out! As with all prescription medication, it is always a good idea to consider potential drug interactions with over-the-counter (OTC) products. This is especially true with some antidepressants, especially SSRIs like Zoloft, as there are several interactions to be aware of. However, in regard to Wellbutrin (bupropion), most OTC drugs are relatively safe to use.
In the next sections, I go over which medications are considered safe to take with Wellbutrin.
Cold Medications Considered Safe To Take With Wellbutrin
Expectorants
Guaifenesin, the active ingredient in Mucinex, is an effective expectorant that helps to thin and clear out mucus that causes chest congestion. There is no listed or reported interaction between guaifenesin and Wellbutrin. They are considered to be safe to use together.
Antihistamines
Antihistamines are considered safe to use. They are used for a wide range of symptoms including post nasal drip, congestion, and allergy symptoms.
Claritin, Zyrtec, and Allegra all last 24 hours and are good options to combine with Wellbutrin if needed.
While most antihistamines are considered safe with Wellbutrin, one exception may be Benadryl. Wellbutrin can inhibit the metabolism of Benadryl (via CYP2D6 inhibition), which can lead to increased concentrations of the drug. This could potentially increase the risk of side effects such as:
- Sedation
- Dry mouth
- Dry eyes
- Constipation
If you are looking for a sedating antihistamine, Unisom, which contains doxylamine, is safe to take with Wellbutrin and does not have the interaction that Benadryl does.
Analgesics
Pain medications, like Tylenol (acetaminophen), Advil (ibuprofen), and Aleve are considered safe to take with Wellbutrin. There are no known drug interactions.
Nasal Steroids
Nasal steroids, such as Flonase, Nasacort, and Rhinocort are safe to take with Wellbutrin.
Zinc/Vitamin C/Cough Drops
Wellbutrin is safe to use with most "natural" cold remedies such as Zinc lozenges and vitamin C.
Use Caution With Wellbutrin
Cough Suppressants
The most common cough suppressant over the counter is dextromethorphan, which is the active ingredient in products such as Delsym and Robitussin DM. Dextromethorphan is available in liquid and solid dosage forms. Most sources list a mild interaction between dextromethorphan and Wellbutrin but the combination is often used together safely.
The mild interaction between the two drugs is that Wellbutrin can inhibit dextromethorphan metabolism. This is due to Wellbutrin inhibition of a liver metabolizing enzyme known as CYP2D6 (which is partly responsible for metabolizing dextromethorphan). This could potentially increase dextromethorphan concentrations. Again, most sources list the combination as OK to take together but to monitor for side effects such as:
- Sedation
- Dizziness
- Fatigue
The above side effects are generally only associated with excessive/overdosages of dextromethorphan.
Dextromethorphan typically should not be used with SSRI (selective serotonin reuptake inhibitors) antidepressants due to a potential risk of a rare but serious condition known as serotonin syndrome. As Wellbutrin does not affect serotonin, the combination is generally considered OK. The combined use of dextromethorphan and Wellbutrin causing serotonin syndrome would be exceedingly rare.
In fact, there is an investigational drug combining Wellbutrin (bupropion) and dextromethorphan for the treatment of resistant depression.
Nasal Decongestants
Common nasal decongestants include phenylephrine and pseudoephedrine. In general, these are safe to use with Wellbutrin as long as you don't have a history or pre-existing risk of seizures.
Wellbutrin is known to increase the risk of seizures, especially with high doses. Stimulants such as pseudoephedrine can increase this risk as well. Caution should be used when combining nasal decongestants and Wellbutrin. If you do not have a history of seizures, the combination may be OK, but be sure to check with your doctor.
Final Words
As you can see, you have a variety of options to help to treat your cough and cold symptoms. If you are looking to take anything that is not listed above, please reach out to us, your pharmacist, or your doctor.
References & sources
- A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor — PubMed
- OTC Dextromethorphan-Induced Serotonin Syndrome — U.S. Pharmacist
- AXS-05axs-05 a new approach to treating multiple CNS conditions. — AXSome
- Dextromethorphan-induced serotonin syndrome — PubMed
- Dextromethorphan Monograph — PubChem
- Bupropion Monograph — PubChem
Glossary — Terms in This Answer
- SSRIs
- A class of antidepressant medications that work by increasing serotonin levels in the brain.
- Expectorant
- A medication that helps thin and clear mucus from the respiratory tract to relieve congestion.
- Antihistamines
- Medications that block histamine to relieve allergy symptoms, congestion, and post nasal drip.
- CYP2D6 inhibition
- When a drug blocks a liver enzyme responsible for breaking down other medications, causing them to build up in the body.
- Metabolism
- The process by which the body breaks down and processes drugs and other substances.
- Serotonin syndrome
- A rare but serious condition caused by dangerously high levels of serotonin in the body.
- Nasal decongestants
- Medications that reduce swelling in nasal passages to relieve congestion and improve airflow.
- Drug interactions
- When two or more medications affect each other's effectiveness or increase the risk of side effects.
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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