Bupropion is an antidepressant that works by affecting norepinephrine and dopamine levels in the brain, unlike many other antidepressants. This unique mechanism requires careful consideration of potential drug interactions.
Absolute Contraindications: The 'Do Not Take' List
Certain substances and conditions are absolute contraindications for bupropion due to severe or life-threatening risks.
Monoamine Oxidase Inhibitors (MAOIs)
Combining bupropion with MAOIs can cause a dangerous spike in blood pressure called a hypertensive crisis. A 14-day gap is required when switching. Examples of MAOIs include phenelzine, selegiline, isocarboxazid, and tranylcypromine, as well as the antibiotic linezolid.
Other Bupropion-Containing Products
Taking more than one medication containing bupropion (e.g., Wellbutrin and Zyban) increases the risk of overdose and seizures.
History of Seizure Disorders or Eating Disorders
Bupropion lowers the seizure threshold and is contraindicated in individuals with a history of seizures, anorexia nervosa, or bulimia.
Abrupt Discontinuation of Sedatives or Alcohol
Suddenly stopping alcohol, sedatives, or seizure medications can trigger seizures, and combining this with bupropion's seizure-lowering effect is particularly risky.
Medications and Substances Requiring Extreme Caution
Other combinations with bupropion require careful medical supervision.
Alcohol Consumption
Mixing bupropion with alcohol is discouraged due to increased seizure risk, especially in heavy drinkers or during withdrawal. It can also worsen side effects and psychiatric symptoms.
Other Medications That Lower Seizure Threshold
Combining bupropion with other drugs that lower the seizure threshold is dangerous. Examples include antipsychotics, tricyclic antidepressants, opioids (like tramadol), stimulants, theophylline, and systemic steroids.
Drugs That Affect Bupropion's Metabolism
Bupropion is metabolized by CYP2B6 and inhibits CYP2D6, leading to potential interactions. Bupropion can increase levels of drugs metabolized by CYP2D6, potentially requiring dose adjustments. Some antivirals and anti-seizure drugs can decrease bupropion levels.
Other Notable Interactions
Combining bupropion with drugs like levodopa can increase side effects. Bupropion can reduce tamoxifen's effectiveness. Monitor blood pressure when combined with nicotine replacement therapy. High caffeine intake can increase stimulant effects and seizure risk.
Comparison Table: Common Bupropion Interactions
| Drug/Substance Class | Type of Interaction | Potential Effect | Recommendation |
|---|---|---|---|
| Monoamine Oxidase Inhibitors (MAOIs) | Pharmacodynamic interaction | Hypertensive crisis (dangerous blood pressure spike) | Absolutely contraindicated. Observe 14-day washout period. |
| Alcohol | Pharmacodynamic interaction | Increased seizure risk, worsened side effects (dizziness, impaired judgment) | Avoid or minimize use. Dangerous, especially with abrupt withdrawal. |
| Other Bupropion Products | Pharmacokinetic interaction | Overdose, significantly increased seizure risk | Never combine different bupropion products (e.g., Wellbutrin, Zyban). |
| CYP2D6 Substrates (e.g., SSRIs, some Beta-Blockers) | Pharmacokinetic interaction | Increased levels and potential toxicity of the other drug | Monitor closely. Dose adjustments may be required. |
| Drugs Lowering Seizure Threshold (e.g., Tramadol, Antipsychotics) | Pharmacodynamic interaction | Additive effect, significantly increasing seizure risk | Use with caution. Start at low doses with close monitoring. |
| Dopaminergic Drugs (e.g., Levodopa) | Pharmacodynamic interaction | Increased CNS side effects (agitation, tremors) | Use with caution. Closely monitor for toxicity. |
The Importance of Full Disclosure to Your Doctor
Always provide your healthcare provider with a complete list of all medications, supplements, and substances you use, including over-the-counter and recreational ones. Never change medications without consulting your doctor or pharmacist.
Conclusion
Bupropion is effective but has significant interaction risks. Avoid MAOIs, other bupropion products, and alcohol. Bupropion is also contraindicated for those with a history of seizures or eating disorders. Many other medications require careful monitoring and dose adjustments. Open communication with your healthcare team is key for safe and effective treatment.
For more detailed information, consult authoritative resources like the {Link: National Alliance on Mental Illness (NAMI) https://www.nami.org/about-mental-illness/treatments/mental-health-medications/types-of-medication/bupropion-wellbut/}.
