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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 [1]
Adverse effects:
- >= 5%
- dizziness, headache, diarrhea, somnolence, dry mouth, sexual dysfunction
- hyperhidrosis
- seizures, mania or hypomania, psychosis
- angle-closure glaucoma
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
Mechanism of action:
- delayed time to relapse in patients with Alzheimer's-related agitation [2]
Interactions
drug interactions
drug adverse effects of antidepressants
General
antidepressant combination
References
- Brooks M
FDA Approves 'Rapid-Acting' Oral Drug for Major Depression.
https://www.medscape.com/viewarticle/979568
- Putka S
Alzheimer's Agitation Relapse Delayed With Dextromethorphan-Bupropion.
Data suggest clinical response with few adverse effects for patients.
MedPage Today April 17, 2024
https://www.medpagetoday.com/meetingcoverage/aan/109714
- Highlights of Prescribing Information
https://www.axsome.com/auvelity-prescribing-information.pdf
Components
bupropion (Wellbutrin, Wellbutrin SR, Zyban, Aplenzin)
dextromethorphan (Benylin DM)