From the Guidelines
Bupropion is not currently considered a first-line treatment for idiopathic hypersomnia (IH), with stronger evidence supporting medications like modafinil, armodafinil, pitolisant, and sodium oxybate. The American Academy of Sleep Medicine clinical practice guideline 1 recommends individualizing treatment selections based on patients' age, pregnancy status, comorbidities, and goals of care. Some case reports and small studies suggest bupropion may help reduce daytime sleepiness in some IH patients, likely due to its action as a dopamine and norepinephrine reuptake inhibitor which promotes wakefulness 1.
When used for IH, bupropion is typically started at 150 mg once daily in the morning for 1-2 weeks, then potentially increased to 150 mg twice daily or 300 mg XL once daily if needed and tolerated. Common side effects include insomnia, dry mouth, headache, and anxiety. Bupropion should be avoided in patients with seizure disorders, eating disorders, or those taking MAOIs. The guideline also suggests that clinicians use modafinil 1, pitolisant 1, methylphenidate 1, and sodium oxybate 1 for the treatment of idiopathic hypersomnia in adults, with varying levels of recommendation strength.
While some patients with IH may benefit from bupropion, particularly those with comorbid depression, it should generally be considered after trials of more established medications have failed or as an adjunctive therapy under the guidance of a sleep specialist. The most recent and highest quality study 1 provides strong evidence for the use of modafinil in treating IH, making it a preferred first-line treatment option.
Key considerations for treatment selection include:
- Patient age and pregnancy status
- Comorbidities, such as cardiovascular disease or allergies
- Risk of dependency or potential for drug misuse
- Goals of care and individual patient needs
- Potential side effects and interactions with other medications.
In summary, bupropion may be considered as an adjunctive therapy or for patients with comorbid depression, but it is not a first-line treatment for idiopathic hypersomnia 1.
From the Research
Evidence for Bupropion in Idiopathic Hypersomnia
- There is limited evidence for the use of bupropion in idiopathic hypersomnia, with only one study 2 reporting its use in a series of 4 patients with severe morning sleep inertia.
- In this study, bedtime long-acting bupropion was effective in reducing morning sleep inertia in 3 out of 4 patients, with benefits maintained at follow-up.
- However, this study had a small sample size and was not a randomized controlled trial, so more research is needed to confirm these findings.
Comparison with Other Treatments
- Modafinil has been shown to be effective in reducing excessive daytime sleepiness in idiopathic hypersomnia in several studies 3, 4, 5.
- Other treatments, such as clarithromycin, have been studied, but the evidence is limited and inconclusive 3.
- A review of non-narcoleptic hypersomnia syndromes mentions bupropion as a potential treatment option, but does not provide specific evidence for its use in idiopathic hypersomnia 6.
Need for Further Research
- There is a need for further studies to investigate the efficacy and safety of bupropion in idiopathic hypersomnia, including randomized controlled trials with larger sample sizes.
- More research is also needed to compare the effectiveness of bupropion with other treatments, such as modafinil, and to determine the optimal treatment strategy for idiopathic hypersomnia.