A 34-year-old man with major depression who also has well-controlled idiopathic generalised epilepsy asks about bupropion. His neurologist counsels him against it primarily because bupropion:

• A Induces CYP3A4 and lowers levels of his antiepileptic drugs
• B Lowers the seizure threshold in a dose-dependent manner ✓
• C Is a strong serotonin-norepinephrine reuptake inhibitor that provokes myoclonus
• D Causes severe hyponatraemia through inappropriate ADH secretion

Explanation

Bupropion, a norepinephrine-dopamine reuptake inhibitor, carries a dose-dependent seizure risk that rises sharply above 450 mg/day, and it is relatively or absolutely contraindicated in epilepsy, eating disorders, and abrupt alcohol withdrawal. Hyponatraemia and serotonin syndrome are problems of SSRIs and SNRIs, not bupropion, which actually has negligible serotonergic action. This lack of sexual dysfunction and weight gain is why bupropion remains attractive otherwise.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.