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Major depressive disorder (MDD) in adults.
This is a combined preparation of Dextromethorphan Hydrobromide and Bupropion Hydrochloride. Dextromethorphan is an uncompetitive antagonist of the NMDA receptor (an ionotropic glutamate receptor) and a sigma-1 receptor agonist. The mechanism of Dextromethorphan in the treatment of MDD is unclear. The mechanism of action of bupropion in the treatment of MDD is unclear; however, it may be related to noradrenergic and/or dopaminergic mechanisms. Bupropion increases plasma levels of Dextromethorphan by competitively inhibiting cytochrome P450 2D6, which catalyzes a major biotransformation pathway for Dextromethorphan. Bupropion is a relatively weak inhibitor of the neuronal reuptake of norepinephrine and dopamine and does not inhibit monoamine oxidase or the reuptake of serotonin.
once daily in the morning.
Strong CYP2B6 inducers: Avoid use.
CYP2D6 Substrates: Increases the exposures of drugs that are substrates of CYP2D6.
Digoxin: May decrease plasma digoxin levels. Monitor digoxin levels.
Drugs that lower seizure threshold: Coadministration may increase risk of seizure.
Dopaminergic drugs: Central Nervous System (CNS) toxicity can occur with concomitant use.
- Dizziness, headache, somnolence
- Diarrhea, dry mouth
- Sexual dysfunction
- Hyperhidrosis
- Seizure: Risk is dose-related. Discontinue if seizure occurs.
- Increased Blood Pressure and Hypertension: this combination can increase blood pressure and cause hypertension. Assess blood pressure before initiating treatment and monitor periodically during treatment.
- Activation of Mania or Hypomania: Screen patients for bipolar disorder.
- Psychosis and Other Neuropsychiatric Reactions: Instruct patients to contact a healthcare provider if such reactions occur.
Combined anxiolytics & anti-depressant drugs
There is limited clinical study experience regarding human overdosage with this combination. Overdosage information is based on experience with the individual components, Dextromethorphan and Bupropion. Metabolism of the Dextromethorphan component of this combination is inhibited by the Bupropion component, such that overdose due to this combination might be more severe or more persistent compared to overdose of dextromethorphan alone.
