From the Guidelines
Auvelity is indicated for the treatment of major depressive disorder (MDD) in adults, offering a unique mechanism of action that may provide benefit for patients who haven't responded adequately to other treatments. The medication contains dextromethorphan and bupropion, which work together to modulate glutamate and increase levels of dopamine and norepinephrine in the brain 1. According to the American College of Physicians, antidepressant therapy, including medications like bupropion, should be assessed regularly for therapeutic response and adverse effects, beginning within 1 to 2 weeks of initiation of therapy 1.
Key Considerations
- The typical dosing regimen for Auvelity begins with one tablet (45 mg dextromethorphan/105 mg bupropion) once daily in the morning for the first three days, then increases to one tablet twice daily, taken at least 8 hours apart.
- Auvelity may work more rapidly than some other antidepressants, with some patients experiencing improvement within 1-2 weeks.
- Common side effects include dizziness, headache, diarrhea, dry mouth, and sexual dysfunction.
- Auvelity should not be used in patients with seizure disorders, eating disorders, or those taking MAOIs, and alcohol consumption should be limited during treatment.
Patient Selection
When selecting patients for Auvelity treatment, it's essential to consider the potential benefits and risks, including the medication's unique mechanism of action and side effect profile 1. Physicians and patients should discuss adverse event profiles before selecting a medication, as differences have been reported among some medications in mild to major adverse effects 1.
Monitoring and Follow-up
Regular monitoring of patients receiving Auvelity is crucial, particularly during the first 1 to 2 months of treatment, to assess for increases in suicidal thoughts and behaviors, agitation, irritability, or unusual changes in behavior 1. If the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy, treatment should be modified, as recommended by the American College of Physicians 1.
From the Research
Indication for Auvelity
The indication for Auvelity is for the treatment of major depressive disorder (MDD) in adults.
- Auvelity, an extended-release fixed combination of dextromethorphan and bupropion, is approved for this purpose 2.
- Studies have shown that Auvelity is effective in reducing symptoms of depression, with significant reductions in Montgomery-Åsberg Depression Rating Scale total scores compared to placebo 3, 4.
- Auvelity has been shown to be effective in patients with moderate-to-severe MDD, with improvements observed as early as week 1 of treatment 4.
- The medication is well-tolerated, with common adverse events being rated as mild-to-moderate 3, 2.
Patient Population
Auvelity is intended for use in adults with MDD.
- A study of real-world treatment patterns found that the majority of patients initiating Auvelity were women, with a mean age of 45.1 years 5.
- Many patients had mental health-related comorbidities, such as anxiety disorders, and had attempted various MDD-related treatments prior to Auvelity 5.
- Auvelity may be used as monotherapy or as an add-on to other treatments, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) 5.