Dextromethorphan and Bupropion

Antidepressant · Antitussive/Dopamine-reuptake inhibitor, antidepressant

Indications

Treatment of major depressive disorder (MDD).

Dosage

Adults: 1 tab once daily in the morning. After 3 days, increase to the max dose of 1 tab twice daily, separated by at least 8 hrs. Do not exceed 2 doses/24 hrs. Children: Not recommended.

Adverse Effects

Headache, dizziness, diarrhoea, somnolence, dry mouth, sexual dysfunction, hyperhidrosis, anxiety, constipation, decreased appetite, insomnia, arthralgia, fatigue, paresthesia, blurred vision.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Severe renal and hepatic impairment. Seizure disorder. Current or prior diagnosis of bulimia or anorexia nervosa. Precautions: Moderate renal impairment. Do not abruptly discontinue alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Do not use this drug within 14 days of discontinuing an MAOI. Assess blood pressure before initiating treatment and monitor periodically during treatment. Bipolar disorder. Mania. Hypomania.

Interactions

SSRIS, TCAs. Strong CYP2D6 inhibitors. Strong CYP2B6 inducers (avoid). CYP2D6 substrates. Digoxin. Dopaminergic drugs.

Advice to Patient

Take with or without meals. Swallow whole tabs. Do not crush, divide or chew. Females of reproductive potential must use effective contraception during treatment or use alternative treatment if planning to become pregnant. Lactating females must avoid nursing babies during treatment and for 5 days after the final dose. Take precautions to reduce falls. Also, Be cautious while operating machinery, driving and doing tasks that require mental alertness. Look for the emergence of suicidal ideation and behaviour, esp early during treatment and when the dose is adjusted up and down. Minimize or avoid use of alcohol.

Pharmacokinetics

Metabolism: Hepatic. Half-life elimination: CYP2D6 extensive metabolizers: Dextromethorphan increased ~3-fold to 22 hrs, compared with dextromethorphan given without bupropion. Bupropion: 15 hrs. Bupropion active metabolites: Hydroxybupropion, erythrohydroxybupropion, and threohydroxybupropion: ~35, 44 and 33 hrs, respectively. Time to peak, plasma: Dextromethorphan: 3 hrs. Bupropion: 2 hrs. Steady state achieved within 8 days. Excretion: Dextromethorphan: CYP2D6 extensive metabolizers: 37-52% in urine (<2% unchanged.) CYP2D6 poor metabolizers: 45-83% in urine (~26% unchanged).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.