Basic Information
ID DDInter1447 and DDInter252
Interaction The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, or any substance that can reduce the seizure threshold (e.g., carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, theophylline).
Management Extreme caution is advised if bupropion is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with a history of seizures or other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Bupropion as well as concomitant medications should be initiated at the lower end of the dosage range and titrated gradually as needed and as tolerated. The maximum recommended dosage for the specific bupropion formulation should not be exceeded. Bupropion should be discontinued and not restarted in patients who experience a seizure during treatment.
References [1] "Product Information. Wellbutrin XL (buPROPion)." GlaxoSmithKline, Philadelphia, PA. [2] Sheehan DV, Welch JB, Fishman SM "A case of bupropion-induced seizure." J Nerv Ment Dis 174 (1986): 496-8 [3] Masco HL, Kiev A, Holloman LC, Batey SR, Johnston JA, Lineberry CG "Safety and efficacy of bupropion and nortriptyline in outpatients with depression." Curr Ther Res Clin Exp 55 (1994): 851-63 [4] "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome, Research Triangle Park, NC. [5] Canadian Pharmacists Association "e-CPS. Available from: URL: http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink." [6] Gittelman DK, Kirby MG "A seizure following bupropion overdose." J Clin Psychiatry 54 (1993): 162 [7] Pisani F, Spina E, Oteri G "Antidepressant drugs and seizure susceptibility: from in vitro data to clinical practice." Epilepsia 40(Suppl 10) (1999): S48-56 [8] "Product Information. Aplenzin (buPROPion)." sanofi-aventis , Bridgewater, NJ. [9] Dufresne RL, Weber SS, Becker RE "Bupropion hydrochloride." Drug Intell Clin Pharm 18 (1984): 957-64 [10] "Product Information. Zyban (bupropion)." Glaxo Wellcome, Research Triangle Park, NC. [11] Johnston JA, Lineberry CG, Ascher JA, et al. "A 102-center prospective study of seizure in association with bupropion." J Clin Psychiatry 52 (1991): 450-6 [12] "Product Information. Wellbutrin SR (bupropion)." Glaxo Wellcome, Research Triangle Park, NC. [13] James WA, Lippmann S "Bupropion: overview and prescribing guidelines in depression." South Med J 84 (1991): 222-4 [14] Storrow AB "Bupropion overdose and seizure." Am J Emerg Med 12 (1994): 183-4 [15] Rosenstein DL, Nelson JC, Jacobs SC "Seizures associated with antidepressants: a review." J Clin Psychiatry 54 (1993): 289-99 [16] "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome, Research Triangle Park, NC. [17] Posner J, Bye A, Jeal S, Peck AW, Whiteman P "Alcohol and bupropion pharmacokinetics in healthy male volunteers." Eur J Clin Pharmacol 26 (1984): 627-30 [18] Ramcharitar V, Levine BS, Goldberger BA, Caplan YH "Bupropion and alcohol fatal intoxication: case report." Forensic Sci Int 56 (1992): 151-6 [19] Hamilton MJ, Bush MS, Peck AW "The effect of bupropion, a new antidepressant drug, and alcohol and their interaction in man." Eur J Clin Pharmacol 27 (1984): 75-80
Alternative for Phentermine A08A
Bupropion
Alternative for Bupropion A08A
Phentermine Naltrexone

N06A
Maprotiline St. John's Wort Oxitriptan Mirtazapine Viloxazine Trazodone
Tryptophan
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.