What is the Incidence of seizure risk with Buproprion?
- With the IR formulation, the rate is 0.4% (4/1000) at doses of 300 to 450 mg/day.
- With the SR formulation, the rate is 0.1% (1/1000) at the target dose of 300 mg/day.
- Incidence of seizure with bupropion XL has not been evaluated.
- This incidence of seizures may exceed that of other antidepressants by as much as 4-fold.
- Incidence increases to ~10 folds between 450-600 mg/day dose.
SO THE RISK OF SEIZURE APPEARS TO BE STRONGLY ASSOCIATED WITH DOSE.
What patient factors may increase the risk of seizure with bupropion?
- History of Head Trauma
- Prior Seizure
- CNS tumor
- Severe Hepatic Cirrhosis
- Concomitant Medications that lowers seizure threshold
- Metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, and hypoxia)
- Use of illicit drugs (e.g., cocaine).
- Abuse or misuse of prescription drugs such as CNS stimulants.
Which co-morbid conditions are associated with increased risk of seizure?
- Excessive use of alcohol or sedatives (including benzodiazepines)
- Addiction to opiates, cocaine, or stimulants
- Use of over-the-counter stimulants and anorectics
- Diabetes treated with oral hypoglycemics or insulin
What are the recommendations for reducing the risk of seizure with Bupropion?
- Total daily dose of Bupropion should not exceed 450 mg/daily.
- Daily dose is administered 3 times daily, with each single dose not to exceed 150 mg to avoid high peak concentrations of bupropion and/or its metabolites.
- Rate of incrementation of dose should be very gradual.
- Bupropion Package Insert.
- J Clin Psychiatry. 1998 Jul; 59(7):366-73.
- Prim Care Companion J Clin Psychiatry. 2005; 7(3): 106–113.
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Dr. Harvinder Singh, M.D. (Admin)
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