Bupropion is preferred over SSRIs in some smokers with depression because of its noradrenergic-dopaminergic profile. However, it is contraindicated in which group because of its characteristic adverse effect profile?
- A Patients with hypertension on beta blockers
- B Patients with bulimia nervosa, due to elevated seizure risk ✓
- C Patients with benign prostatic hypertrophy
- D Patients with type 2 diabetes on metformin
Correct answer: B. Patients with bulimia nervosa, due to elevated seizure risk
Explanation
Bupropion is a norepinephrine-dopamine reuptake inhibitor with dose-dependent lowering of the seizure threshold; the incidence rises sharply above 450 mg/day. Electrolyte disturbances and purging in bulimia nervosa further increase seizure risk, so the drug is contraindicated in eating disorders and in epilepsy. Insomnia, dry mouth and hypertension are recognised but do not form absolute contraindications comparable to the seizure risk in these patients.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
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