Nurses Compass
Drug Guide
Bupropion Hydrobromide
Classification
Therapeutic: Antidepressant, Smoking Cessation Aid
Pharmacological: Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
FDA Approved Indications
- Major depressive disorder (MDD)
- Seasonal affective disorder (SAD)
- Smoking cessation (as adjunct)
Mechanism of Action
Bupropion inhibits the reuptake of norepinephrine and dopamine, increasing their levels in the synaptic cleft, which helps improve mood and reduce nicotine withdrawal symptoms.
Dosage and Administration
Adult: Initially 174 mg per day, given as 87 mg twice daily, titrating up as tolerated to a maximum of 300 mg per day in divided doses.
Pediatric: Not approved for pediatric use.
Geriatric: Start with lower doses due to increased sensitivity, monitor closely.
Renal Impairment: Use with caution; dose adjustments may be necessary.
Hepatic Impairment: Use caution; lower doses may be required.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, crosses the blood-brain barrier.
Metabolism: Metabolized hepatically, primarily via CYP2B6.
Excretion: Eliminated mainly in urine as metabolites.
Half Life: About 21 hours, facilitating once or twice daily dosing.
Contraindications
- Seizure disorder
- History of anorexia or bulimia nervosa
- Discontinuation syndrome after alcohol or abrupt drug withdrawal
- Use of monoamine oxidase inhibitors within 14 days
Precautions
- Risk of seizures, monitor for hypersensitivity, caution in patients with hepatic impairment, history of head trauma, or at risk of hyponatremia.
Adverse Reactions - Common
- Insomnia (Common)
- Dry mouth (Common)
- Sweating (Common)
- Nausea (Common)
Adverse Reactions - Serious
- Seizures (Rare)
- Hypertension (Less common)
- Psychiatric symptoms (e.g., agitation, hallucinations) (Uncommon)
Drug-Drug Interactions
- Principal substrate of CYP2B6 (e.g., clopidogrel, cyclophosphamide)
- Other serotonergic drugs (risk of serotonin syndrome)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor mental status, seizure history, blood pressure, and signs of adverse effects.
Diagnoses:
- Risk for seizure
- Imbalanced nutrition: less than body requirements
- Risk for hypertension
Implementation: Start at low dose, titrate gradually, monitor for adverse effects, counsel on seizure risk.
Evaluation: Evaluate effectiveness in depression or smoking cessation, monitor for adverse effects, seizure activity.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report any signs of agitation, hallucinations, or seizures.
- Avoid alcohol and sedatives.
- Attend regular follow-up appointments.
Special Considerations
Black Box Warnings:
- Risk of suicide in children, adolescents, and young adults.
Genetic Factors: CYP2B6 genetic polymorphisms can affect metabolism and plasma levels.
Lab Test Interference: N/A
Overdose Management
Signs/Symptoms: Seizures, hallucinations, tachycardia, hyperthermia, possibly coma.
Treatment: Supportive care, activated charcoal if ingestion is recent, seizure management, airway support, intensive monitoring.
Storage and Handling
Storage: Store at room temperature, away from moisture, heat, and light.
Stability: Stable under recommended storage conditions.