Overview
Bupropion is an atypical antidepressant used primarily for major depressive disorder. It works as a norepinephrine-dopamine reuptake inhibitor (NDRI) with minimal serotonergic effects, distinguishing it from SSRIs. The medication carries warnings about increased seizure risk and requires careful monitoring for neuropsychiatric effects.
Mechanism of Action
Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that selectively inhibits the neuronal reuptake of norepinephrine and dopamine with minimal effect on serotonin reuptake. This unique mechanism increases synaptic concentrations of these neurotransmitters in the brain, contributing to its antidepressant effects.
Indications
- Treatment of major depressive disorder (MDD)
Common Doses
- 100 mg
- 150 mg
- 200 mg
Dosage
Typical starting dose is 100 mg twice daily, with gradual titration to minimize seizure risk. Maximum recommended dose is 450 mg per day in divided doses. Dosing adjustments are required for hepatic impairment.
Black Box Warning
Black box warning for suicidal thoughts and behaviors in children, adolescents, and young adults
Contraindications
- Seizure disorder
- Current or prior diagnosis of bulimia or anorexia nervosa
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
- Concomitant use with MAOIs or within 14 days of discontinuing MAOIs
- Known hypersensitivity to bupropion or tablet ingredients
Side Effects
- Insomnia
- Dry mouth
- Headache
- Nausea
- Agitation
- Anxiety
- Tremor
- Increased risk of seizures
- Hypertension
- Hypersensitivity reactions including anaphylaxis and Stevens-Johnson syndrome
Interactions
- MAO inhibitors (contraindicated)
- Drugs that lower seizure threshold
- CYP2B6 inhibitors (may increase bupropion levels)
- Alcohol (increases seizure risk)
- Linezolid and intravenous methylene blue
Counseling Points
- Take exactly as prescribed; do not crush, chew, or split tablets
- Report any new or worsening depression, suicidal thoughts, or unusual behavior changes
- Avoid alcohol consumption due to increased seizure risk
- Monitor blood pressure regularly
- Report seizures, allergic reactions, or vision changes immediately
- Do not discontinue abruptly without medical supervision