HAART and Wellbutrin

[somme19160701]

Hello:

I have a wild type virus and have been working with a clinical pharmacist to choose my first HAART regimen. Due to my history of depression, she has recommended against taking efavirenz or rilpivirine. I have an unpredictable schedule that makes taking any medication around supper time difficult, so she suggested three possible once-daily regimens: Stribild, or Truvada with either boosted darunavir or once-daily etravirine. My insurance would pay for any one of the three combinations.

Etravirine has not been approved for treatment-naive patients in Canada, and taking it once daily is an off-label indication. Etravirine is also not a preferred or alternative third agent in any of the guidelines I've read. I want to avoid integrase inhibitors for now so I have the option of switching to once-daily dolutegravir in the future when it's covered under the provincial formulary.

I'm concerned about boosted darunavir because of a potential drug-drug interaction with Wellbutrin. I've taken both citalopram and up to 300 mg of Wellbutrin a day for depression in the past. Both seemed effective, but the side effects from citalopram were severe, and I'd like to avoid SSRI's in the future. I've been off of antidepressants since July, but my depression has been getting worse over the past month and I'm likely to re-start Wellbutrin soon. All protease inhibitors reduce the bioavailability of Wellbutrin. The dose of Wellbutrin isn't normally increased beyond 300 mg a day because of the risk of causing seizures at higher doses.

I'd like to know if anyone taking Wellbutrin for depression has experienced worsening symptoms after starting a protease inhibitor. I'm also curious whether anyone's doctor has suggested once-daily etravirine as part of a first-line regimen, and why.

Thanks for your help,

G

[MadisonTeddy]

Good morning...I am on my 5 week of Atripla and on 300 mg of Wellbutrin...No issues, side effects or other red flags...Good luck..

[Joe K]

I'd like to know if anyone taking Wellbutrin for depression has experienced worsening symptoms after starting a protease inhibitor. I'm also curious whether anyone's doctor has suggested once-daily etravirine as part of a first-line regimen, and why.

I have taken Wellbutrin for years, with and without PIs.  I am currently on Truvada/Viramune, Wellbutrin SR 300mg, Wellbutrin 100mg and Citalopram 40mg.  I also take Methylphenidate (Ritilin) SR 40mg and a fast acting version (10mg) if I need a little boost in the afternoon.

I encourage you to work with your doctors to find a formula that works for you.  It took me a couple of years to get this balance, but it's worked now for almost 6 years.

Joe

[Miss Philicia]

Goodness -- how in the world do you sleep on all of that? I've taken Wellbutrin and it makes me shaky and gives me insomnia, and you don't even want to know what happened when they raised me to 20mg of citalopram. If I added prescription meth on top of that I would surely have a heart attack.

That said, in my experience Wellbutrin is probably the most often prescribed anti-depressant for at least gay men due to its low side effect profile for both weight gain and sexual dysfunction issues.

[TheStynque-1]

Take a look at Stribild-I was treatment naive myself and started stribild on 06/26/13 and experienced absolutely no side effects what so ever. I'm on Lexapro (Escitalopram) myself so I cannot share any experience with Wellbutrin. There are no drug interactions between Wellbutrin and Stribild to worry about. Plus Stribild is recommended for Treatment Naive patients.
http://www.drugs.com/uk/stribild.html
Good Luck!

[mrtoad]

Wellbutrin makes me think suicide out of the blue-weird.And no sex drive either.Though all meds seem to do the later.Or have sex drive but cannot ..er,shall we say complete the mission.20 mg of Citalopram is the only tolerable it seems for me.

[Since1993]

I've taken Wellbutrin XL 300 mg daily along with Prezista, Ritanovir, and Epzicom for about a year without any known side-effects.  I also took it alongside Atripla briefly until my psych and ID doctor decided it might have contributed to my depression and possibly renal toxicity so Atripla was discontinued.

Wellbutrin XL is designed to give you a little "pep to your step" throughout the day.  Psychiatry recommended taking it early in the morning so it wouldn't disrupt rest at night.  I've not had any specific issues taking Wellbutrin. 

[mrtoad]

I correct myself- 10 mg of Citalopram , not 20