From the Guidelines
Bupropion should be used with caution due to its association with a small increased incidence of seizures, particularly in patients with a history of seizure or other risk factors, as reported in a study published in the Mayo Clinic Proceedings in 2009 1. When considering the use of bupropion, it is essential to weigh the benefits against the potential risks, including the risk of seizures.
- The seizure risk associated with bupropion is approximately 1/1000, as noted in the study 1.
- Patients with a history of seizure, structural brain lesion, or other risk factors should be closely monitored while taking bupropion.
- The dose of bupropion should not exceed 300 mg/day to minimize the risk of seizures, as higher doses may increase the risk.
- Bupropion should be avoided in patients with a seizure disorder, current or prior diagnosis of bulimia or anorexia nervosa, or those undergoing abrupt discontinuation of alcohol or sedatives, due to the increased risk of seizures 1. Some key points to consider when prescribing bupropion include:
- Monitoring patients for signs of seizure, such as tremors, rash, headache, and urticaria, which may indicate an increased risk of seizure.
- Avoiding the use of bupropion in patients with other risk factors, such as head trauma, CNS tumors, severe liver cirrhosis, or use of medications that lower seizure threshold.
- Discontinuing bupropion immediately if a patient experiences a seizure while taking the medication, as reported in the study 1.
From the FDA Drug Label
Bupropion hydrochloride extended-release tablets (XL) can cause seizure. The risk of seizure is dose-related. The dose should not exceed 300 mg once daily. Increase the dose gradually. Discontinue bupropion hydrochloride extended-release tablets (XL) and do not restart treatment if the patient experiences a seizure The risk of seizures is also related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold. The incidence of seizure with bupropion hydrochloride extended-release tablets (XL) has not been formally evaluated in clinical trials. In studies using bupropion HCl sustained-release up to 300 mg per day the incidence of seizure was approximately 0.1% (1/1000 patients).
Bupropion and Seizures: Bupropion can cause seizures, with a dose-related risk. The risk of seizure is increased with doses above 300 mg once daily. Patient factors, clinical situations, and concomitant medications that lower the seizure threshold also increase the risk of seizures. The incidence of seizure with bupropion is approximately 0.1% (1/1000 patients) at doses up to 300 mg per day 2.
- Key Points:
- Bupropion can cause seizures
- Risk of seizure is dose-related
- Dose should not exceed 300 mg once daily
- Discontinue treatment if patient experiences a seizure
- Patient factors and concomitant medications can increase the risk of seizures
From the Research
Bupropion and Seizures
- Bupropion is known to have an epileptogenic potential, and it may lower the convulsive threshold, making it not recommended for individuals who may be predisposed to seizures 3.
- The observed incidence of seizures with bupropion doses of 450 mg/day or less ranged from 0.35%-0.44%, depending on the method of calculation 4.
- The risk of seizure appears to be higher with bupropion doses above the recommended maximum, and predisposing factors were noted in over half of the reported cases 4.
- Clinical features associated with seizure after bupropion overdose include QTc >500, tachycardia, and age 13-18 years 5.
- Antidepressant exposure, including bupropion, is positively associated with increased seizure risk, with a clear dose-response effect 6.
- The seizure-inducing propensity and dose-response relationship pattern, as well as potential risk factors, associated with individual antidepressants, should be taken into consideration when choosing antidepressants during clinical practice 6.
- Combining serotonin reuptake inhibitors and bupropion in partial responders to antidepressant monotherapy appears to be safe and often more effective than monotherapy, with no reported seizures in one uncontrolled clinical series 7.
Risk Factors
- Predisposing factors, such as a history of seizures or head trauma, may increase the risk of seizures with bupropion use 3, 4.
- Age, particularly between 10 and 24 years, is a potential risk factor for seizures with bupropion use 6.
- Dose and dosing schedule may also play a role in the risk of seizures with bupropion, with higher doses and certain dosing schedules potentially increasing the risk 4, 6.