Bupropion Alcohol

ALCOHOL BUPROPION Rare reports of adverse neuropsychiatric events, including report of seizures. 1 alcohol tolerance Uncertain Warn patients to avoid or minimize alcohol intake during bupropion treatment... 

Clinically important, potentially hazardous interactions with alcohol, bupropion, kava, MAO inhibitors, methylphenidate, selegiline, St John s wort, sumatriptan, valerian... 

Margolin A, Kosten TR, Avants SK, et al A multicenter trial of bupropion for cocaine dependence in methadone-maintained patients. Drug Alcohol Depend 40 125— 131, 1995... 

Alcohol Health Res World 22 122-123, 1998 Solhkhah R, Finkel J, Hird S Possible risperidone-induced visual hallucinations. J Am Acad Child Adolesc Psychiatry 39 1074-1073, 2000 Solhkhah R, Wilens TE, Prince JB, et al Bupropion sustained release for substance abuse, ADHD, and mood disorders in adolescents (NR31), in New Research Absrracts, Annual Meeting of the American Psychiatric Associarion. Washington, DC, American Psychiatric Associarion, 2001... 

Hall SM, Reus VI, Munoz RF, et al Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry 55 683-690, 1998 Hall SM, Humfleet GL, Reus VI, et al Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiatry 59 930-936, 2002 Hayford KE, Patten CA, Rummans TA, et al Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry 174 173-178, 1999... 

Lerman, C.R.D., Kaufmann, V., Audrain, J., Hawk, L., Liu, A., Niaura, R., Epstein, L. Mediating mechanisms for the impact of bupropion in smoking cessation treatment. Drug Alcohol Depend. 67 219, 2002. 

Hypersensitivity to the drug seizure disorder current or prior diagnosis of bulimia or anorexia nervosa concurrent administration of a monoamine oxidase inhibitor (MAOl) (at least 14 days should elapse between discontinuation of an MAOl and initiation of treatment with bupropion) in patients being treated with other bupropion products (eg, for smoking cessation) in patients undergoing abrupt discontinuation of alcohol or sedatives (including benzodiazepines). 

Drugs that may be affected by bupropion include alcohol, drugs metabolized by... 

Antidepressants appear sometimes useful in aiding withdrawal attempts, rather as they can he in withdrawal from benzodiazepines or alcohol. There is some positive evidence for serotonin re-uptake inhibitors and nortriptyline, but the strongest is for bupropion, which in the UK at least is the only antidepressant licensed for use as a cessation aid. Success rates for this seem to be very similar to those with nicotine replacement, approximately doubling a smoker s chances (Hughes et al. 2007). The latest option is varenicline, which acts as a partial agonist on one of the nicotinic receptors. 

Specific factors to consider are both psychiatric and physical contraindications. For example, bupropion is contraindicated in a depressed patient with a history of seizures due to the increased risk of recurrence while on this agent. Conversely, it may be an appropriate choice for a bipolar disorder with intermittent depressive episodes that is otherwise under good control with standard mood stabilizers. This consideration is based on the limited data suggesting that bupropion is less likely to induce a manic switch in comparison with standard heterocyclic antidepressants. Another example is the avoidance of benzodiazepines for the treatment of panic disorder in a patient with a history of alcohol or sedative-hypnotic abuse due to the increased risk of misuse or dependency. In this situation, a selective serotonin reuptake inhibitor (SSRI) may be more appropriate. 

In contrast to anticonvulsants and alcohol, drugs such as bupropion, fluoxetine, fluvoxamine, nefazodone, quinidine, paroxetine, and some antipsychotics can inhibit specific CYP enzymes (7, 11, 36, 37, 41, 42, 43 and 44). Thus, TCAs, certain BZDs, bupropion, some steroids, and antipsychotics can all have their metabolism inhibited by drugs such as fluoxetine. For example, fluoxetine at 20 mg/day produces on average a 500% increase in the levels of coprescribed drugs which are principally dependent on CYP 2D6 for their clearance. That can lead to serious or even life-threatening toxicity if the drug has a narrow therapeutic index and the dose is not adjusted for the change in clearance caused by the coadministration of fluoxetine. 

Although more stimulating antidepressants (e.g., bupropion, SSRIs, venlafaxine, or certain MAOIs) do not potentiate alcohol, they can produce insomnia. To minimize this problem, the dose may be given earlier in the day. TCAs may cause episodes of excitement (rare), confusion, or mania, usually in patients with an underlying psychotic illness, suggesting that a preexisting disorder must be present for these drugs to exert any psychotomimetic effects. 

With the exceptions of methadone maintenance, LAAM maintenance, and nicotine substitution therapy (and probably naltrexone for alcohol addiction and bupropion for nicotine addiction), no clearly effective pharmacotherapy for drug addiction exists. Certainly, no broadly effective pharmacotherapy exists (effective for addictions to drugs of different chemical classes and pharmacological categories). Therapeutic strategies based on psychotherapy, group therapy, behavior modification, economic incentives, and aversion deconditioning have proven limited. 

Psilocybin Booze see Alcohol Boppers see Inhalants Botanicals see Herbal drugs Boy see Heroin Brain pills see Amphetamines Brain ticklers see Amphetamines Brevital see Barbiturates Bromo see 2C-B Brownies see Amphetamines Browns see Amphetamines Bubalbital see Barbiturates Bullet see Inhalants Bullet bolt see Inhalants Bumblebees see Amphetamines Bumetanide see Diuretics Bupropion see Antidepressants Bush see Marijuana Bushman s tea see Catha edulis Businessman s LSD see Dimethyltryptamine (DMT) Businessman s special see Dimethyltryptamine (DMT) Businessman s trip see Dimethyltryptamine (DMT) Buspirone see Tranquilizers Busy bee see PCP (phencyclidine)... 

Bupropion Hydrochloride Bupropion interacts with levodopa, nicotine, alcohol, and drugs that affect hepatic metabolic enzymes. It lowers the seizure threshold and potentiates the seizure threshold-lowering effect of other antidepressants.135... 

Do nof combine wifh anofher MAO inhibitor, alcohol, buspirone, bupropion, or guanefhidine... 

Excitation, seizures, delirium, hyperpyrexia, circulatory collapse, coma, and death may result from combining MAO inhibitors wifh mepiridine or dexfromefhorphan Do not combine with another MAO inhibitor, alcohol, buspirone, bupropion, or guanethidine... 

Several antidepressants work via mechanisms that are not yet fully understood. Perhaps the best example of this is bupropion (3). Although the mechanism of action of bupropion is most commonly attributed to inhibition of dopamine reuptake, its actions are diverse (215).In addition, one or more bupropion metabolites also seem to be active. In humans, bupropion is metabolized to two amino alcohols, the racemic threo amino alcohol RyR-threo 66) and the racemic erythro amino alcohol (i ,S-erythro 67), threohydroxybupro-pion and crythrohydroxybupropion, respectively and a morpholinol, hydroxybupropion (68 BW 306U). The levels and half-lives of... 

Richmond R, Zwar N (2003) Review of bupropion for smoking cessation. Drug Alcohol Rev 22 203-220... 

Bupropion administered as a single dose of 100 mg did not exhibit clinically significant pharmacokinetic interactions with alcohol. 

Other clinical uses Tricyclic drugs are also used in the treatment of bipolar affective disorders, acute panic attacks, phobic disorders (compare with alprazolam Chapter 22), enuresis, and chronic pain states. Clomipramine and the selective serotonin reuptake inhibitors, including fiuvoxamine, are effective in obsessive-compulsive disorders. SSRls are also effective in patients who suffer from panic attacks, social phobias, bulimia, and premenstrual syndrome (PMS) and may also be useful in the treatment of alcohol dependence. Bupropion is used for management of patients attempting to withdraw from nicotine dependence. 

Bupropion hydroxylation of the tert-butyl group to hydroxypropion is mediated almost exclusively by CYP2B6 and, to a lesser extent, by CYP2E1 (74). Other metabolites include reduction of the aminoketone to amino-alcohol isomers, threo-hydrobupropion and erythro-hydrobupropion (Fig. 21.21). Further oxidation of the bupropion side chain results in the formation of m-chlorobenzoic acid, which is eliminated in the urine as its glycine conjugate. Hydroxybupropion is approximately 50% as potent as bupropion, whereas threo-hydrobupropion and erythro-hydrobupropion have 20% of the potency of bupropion. Peak plasma concentrations for hydroxybupropion are approximately 10 times the peak level of the parent drug at steady state, with an elimination half-life of approximately 20 hours. The times to... 

---