Bupropion- Check Your Basics

Q. Check the FALSE statement regarding Bupropion (Wellbutrin):

(a) Bupropion is least likely to precipitate mania of all antidepressants in patient with bipolar disorder.
(b) Incidence of seizure at 300mg/day for Sustained release Bupropion is worse than seizure incidence with other antidepressants.
(c) Bupropion can cause false positive urine drug screen for amphetamines.
(d) Bupropion use in patient with psychotic disorder is known to worsen the psychosis.

B

From the Manual of Clinical Psychopharmacology, 7th Edition, Chapter 3, Antidepressants.

"Seizures for the immediate-release formulation of the drug have been reported at the rate of 4 per 1,000 at dosages less than 450 mg/day; this risk increased to 4 per 100 when the dosage was increased above 450 mg/day. The sustained-release formulation, which has largely supplanted the immediate-release formulation, appears to carry a seizure risk of about 1 per 1,000 patients at dosages less than 400 mg/day. This risk is similar to the seizure risk associated with most antidepressants. The risk of seizures appears to be enhanced in patients with a prior history of seizure disorders, head injury, bulimia, and anorexia. Concurrent use of alcohol, stimulants, or cocaine also enhances the risk of seizures in these patients. The manufacturer also cautions that single doses of the drug should never exceed 150 mg for the immediate-release formulation and 200 mg for the sustained-release preparation. The XL formulation may be taken as a single dose of up to 450 mg. "

Absolutely correct tjamrose

- Bupropion is least likely to precipitate mania of all antidepressants in patient with bipolar disorder.
Source: Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007; 356:1711–1722

- Incidence of seizure at 300mg/day for Sustained release Bupropion is worse than seizure incidence with other antidepressants.
Source: good explanation above by tjamrose

- Bupropion can cause false positive urine drug screen for amphetamines.
Source: Frequency of false positive
amphetamine screens due to bupropion using the Syva EMIT II immunoassay. J Med
Toxicol. 2011 Jun;7(2):105-8.

- Bupropion use in patient with psychotic disorder is known to worsen the psychosis.

More Facts on Bupropion:

* Two important uses of Bupropion as an adjunct to SSRIs:
- To augment the antidepressant effect,
- To counteract the sexual side effects of SSRIs.

* Probably not effective in the treatment of anxiety disorders.

* Most common side effect of sustained release Bupropion is Insomnia, dry mouth and Tremor (at dose of 100-300mg/day).

* Maximum recommended single dose and strength of Bupropion:
- IR: < 150mg single dose
- SR: < 200mg single dose
- XL: < 450mg single dose

* Bupropion metabolized by CYP 2B6: so less drug interactions. Drugs like Orphenadrine and Cyclophosphamide affected.

Please add more high yield facts on Bupropion. Thanks

Bupropion is indeed metabolized by cyp2B6, but it is also a strong inhibitor of cyp2D6, which metabolizes many psychiatric and non-psychiatric medications. A red flag should emerge in a psychiatrist's mind before prescribing bupropion to check for other medications the patient is taking that are metabolized by 2D6. A medication that is ONLY metabolized by 2D6 will increase by three fold or greater, which can, obviously, have serious pharmacodynamic repercussions.