bupropion/dextromethorphan (Auvelity)

Indications

• treatment of major depression in adults
• treatment of psychosis & agitation in the elderly

Contraindications

• seizure disorder, epilepsy
• bulimia or anorexia nervosa
• concurrent use within 14 days of MAO inhibitor
• pregnancy, lactaction
• severe renal impairment
• severe hepatic impairment

Dosage

• start: 1 tablet QAM
• after 3 days, increase to maximum of 1 tablet BID (>= 8 hours apart)
• swallow tablet whole; do not crush, divide or chew

Extended release tablet: dextromethorphan 45 mg & bupropion 105 mg

Dosage adjustment in renal failure

• max: 1 table QD with moderate renal impairment

Pharmacokinetics

• rapid-acting oral medicine
• statistically significant antidepressant efficacy vs placebo after 1 week

Adverse effects

• >= 5%
  • dizziness, headache, diarrhea, somnolence, dry mouth, sexual dysfunction
  • hyperhidrosis
• seizures, mania or hypomania, psychosis
• angle-closure glaucoma

• drug adverse effects of antidepressants
• drug adverse effects of psychotropic agents

Drug interactions

• bupropion inhibits CYP2D6
  • strong CYP2D6 inducer: avoid use
  • strong CYP2D6 inhibitors: limit dose to 1 tabet/day
  • CYP2D6 substrates: Auvelity may increase plasma levels
• Auvelity may decrease plasma digoxin levels
• use in combination with SSRIs or tricyclic antidepressants increases the risk of serotonin syndrome
• drugs that lower seizure threshold

• drug interaction(s) of antidepressant in combination with GLP1-agonist
• drug interaction(s) of dextromethorphan with SSRIs
• drug interaction(s) of benzodiazepines with antidepressants
• drug interaction(s) of antidepressants with benzodiazepines
• drug interaction(s) of NSAIDs with antidepressants
• drug interaction(s) of antidepressant with opiates

Mechanism of action

• delayed time to relapse in patients with Alzheimer's-related agitation

More general terms

• antidepressant combination

Components

• bupropion (Wellbutrin, Wellbutrin SR, Zyban, Aplenzin)
• dextromethorphan (Benylin DM)