Class: Monocyclic Antidepressant
Dosage Forms. Tablet (Immediate Release): 75 mg, 100 mg; Tablet (Sustained Release 12 h): 100 mg, 150 mg, 200 mg; Tablet (Extended Release 24 h): 150 mg, 300 mg, 450 mg; Tablet (Hydrobromide. Extended Release 24 h): 174 mg, 348 mg, 522 mg
Common FDA Label Indication, Dosing, and Titration.
1. Depression: Immediate release, 100 mg po bid × 3 d, increase to 100 mg po tid (max 450 mg/d); Sustained release, 150 mg po daily in the morning × 1 wk, increase to 150 mg po bid (max 200 mg bid); Extended release, 150 mg po daily × 3 d, then increase to 300 mg po daily (max 450 mg/d)
2. Seasonal affective disorder (SAD): 150 or 174 mg once daily in the morning, may titrate to 300 or 348 mg once daily in the morning
3. Smoking cessation assistance: Sustained release, 150 mg po daily in the morning × 3 d, then 150 mg po bid (max 300 mg/d) for 7-12 wk; begin treatment 1 wk prior to smoking quit date
Off-Label Uses. None
MOA. Bupropion is a monocyclic antidepressant, unique as a mild dopamine and norepinephrine uptake inhibitor with no direct effect on serotonin receptors or MAO.
Drug Characteristics: Bupropion
Medication Safety Issues: Bupropion
Drug Interactions: Bupropion
Adverse Reactions: Bupropion
Efficacy Monitoring Parameters. Improvement in depressive symptoms, may require 4-6 wk. Abstinence from tobacco products.
Toxicity Monitoring Parameters. Worsening of depression, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases. Blood pressure and heart rate in patients using concomitant nicotine replacement therapy.
Key Patient Counseling Points. Avoid alcohol, CNS depressants, and activities requiring mental alertness. Take at the same time each day and at bedtime if possible.
Clinical Pearls. Not FDA approved for use in children. Depression, suicidal ideation, attempts, and suicides occur in patients with and without preexisting psychiatric disease. When switching patients from immediate- or sustained-release tablets to extended-release tablets, give the same total daily dose when possible. Medication safety guide required.