Ciclosporin Bupropion

Nervous system Seizures have been attributed to flumazenil [104, 105, 106, 107, 108, 109, 110, 111 ], including status epilepticus [112, 113 ], which can be fatal. However, it has been suggested that seizures are not a toxic effect of flumazenil, but are in many cases instead due to unmasking of the anticonvulsant effect of the benzodiazepine or to a severe benzodiazepine-withdrawal syndrome furthermore, in some cases they may be due to other drugs taken at the same time, such as tricyclic antidepressants [1143]. Thus, it has been recommended that flumazenil should not be given to patients who have used benzodiazepines for seizure disorders or to patients who have taken other drugs that increase the risk of seizures (e.g. bupropion, ciclosporin, cocaine, cyclic antidepressants, isoniazid, lithium, methylxanthines, monoamine oxidase inhibitors, and propoxyphene). 

Potential drug-drug interactions of ciclosporin with methylphenidate and amfebutamone (bupropion) have been described (43). 

An isolated case describes a lai e fall in ciclosporin levels in a 10-year-old boy given bupropion. 

A 10-year-old boy, who had received a heart transplant 6 years previously started taking bupropion 75 mg twice daily in addition to his usual transplant medication, which included ciclosporin. After taking bupropion for 22 days, his ciclosporin level was found to be only 39 nanograms/mL. The last level taken before bupropion treatment had heen 197 nanograms/mL. Despite an increase in his ciclosporin dose from 420 to 500 mg daily, the ciclosporin levels fell further, to 27 nanograms/mL. The ciclosporin dosage was then increased to 550 mg daily and bupropion was stopped. ... 

The reason for this probable interaction is unclear, although an interaction via the cytochrome P450 isoenzyme CYP3A4 is a possibility. This appears to be the only reported case of an interaction between ciclosporin and bupropion, and its general importance is unknown. 

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