A 24-year-old woman with recurrent major depression is being considered for bupropion. Her history includes daily purging behaviour after binges for the past three years, with hypokalaemia noted last month. Why should this drug be avoided?
- A It substantially lowers the seizure threshold, and electrolyte disturbance further raises this risk ✓
- B It worsens purging through dopaminergic stimulation of appetite
- C It causes dangerous hypertension when combined with vomiting
- D It precipitates amenorrhoea via prolactin elevation
Correct answer: A. It substantially lowers the seizure threshold, and electrolyte disturbance further raises this risk
Explanation
Bupropion is contraindicated in patients with eating disorders, especially those who purge, because it dose-dependently lowers the seizure threshold; dehydration and electrolyte abnormalities such as hypokalaemia compound this risk. Bupropion does not raise prolactin (it may actually lower it), does not cause hypertensive reactions (that is the tyramine interaction of MAOIs), and its noradrenergic-dopaminergic action tends to suppress rather than stimulate appetite.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.