Basic Information
ID DDInter1653 and DDInter252
Interaction Coadministration of bupropion with other drugs that also inhibit the reuptake of dopamine or norepinephrine, including monoamine oxidase inhibitors (MAOIs), may increase the risk of hypertensive reactions. Additionally, MAOIs can increase dopaminergic and noradrenergic activity by inhibiting the metabolism of dopamine and norepinephrine.
Management Concurrent use of bupropion with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, procarbazine) is considered contraindicated. At least 14 days (or 24 hours for reversible MAOIs such as moclobemide and linezolid) should elapse between discontinuation of MAOI therapy and initiation of treatment with bupropion. Conversely, at least 14 days should elapse after discontinuation of bupropion and initiation of MAOI therapy.
References [1] James WA, Lippmann S "Bupropion: overview and prescribing guidelines in depression." South Med J 84 (1991): 222-4 [2] Schulz R, Antonin KH, Hoffmann E, et al "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36 [3] "Product Information. Zyvox (linezolid)" Pharmacia and Upjohn, Kalamazoo, MI. [4] Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7 [5] De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5 [6] "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome, Research Triangle Park, NC. [7] "Product Information. Matulane (procarbazine)." Roche Laboratories, Nutley, NJ. [8] "Product Information. Marplan (isocarboxazid)" Roche Laboratories, Nutley, NJ. [9] "Product Information. Zyvox (linezolid)" Pharmacia and Upjohn, Kalamazoo, MI. [10] Pohl R, Balon R, Berchou R "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry 145 (1988): 651 [11] Zetin M, Plon L, DeAntonio M "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry 48 (1987): 499 [12] Ban TA "Drug interactions with psychoactive drugs." Dis Nerv Syst 36 (1975): 164-6 [13] Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6 [14] Maxwell MB "Reexamining the dietary restrictions with procarbazine (an MAOI)." Cancer Nurs 3 (1980): 451-7 [15] "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation, Eatontown, NJ. [16] Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7 [17] Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31 [18] Nuessle WF, Norman FC, Miller HE "Pickled herring and tranylcypromine reaction." JAMA 192 (1965): 142-3 [19] Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62 [20] Walker JI, Davidson J, Zung WWK "Patient compliance with MAO Inhibitor therapy." J Clin Psychiatry 45 (1984): 78-80 [21] De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5 [22] Sweet RA, Liebowitz MR, Holt CS, Heimberg RG "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol 11 (1991): 331-2 [23] Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol 14 (1994): 5-14 [24] Domino EF, Selden EM "Red wine and reactions." J Clin Psychopharmacol 4 (1984): 173-4 [25] "Product Information. Nardil (phenelzine)." Parke-Dvis, Morris Plains, NJ. [26] "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome, Research Triangle Park, NC. [27] 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 [28] 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 [29] Ramcharitar V, Levine BS, Goldberger BA, Caplan YH "Bupropion and alcohol fatal intoxication: case report." Forensic Sci Int 56 (1992): 151-6
Alternative for Selegiline N04B
Tolcapone Opicapone
Alternative for Bupropion A08A
Lorcaserin Orlistat Naltrexone

N06A
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.