Auvelity Dosing
Start with one tablet (dextromethorphan 45 mg/bupropion 105 mg) once daily in the morning for 3 days, then increase to the maintenance dose of one tablet twice daily, separated by at least 8 hours. 1
Standard Dosing Regimen
- Days 1-3: One tablet once daily in the morning
- Day 4 onward: One tablet twice daily (morning and afternoon/evening)
- Maximum: Two tablets per day total
- Administration: Swallow tablets whole; do not crush, divide, or chew
- Timing: Separate doses by at least 8 hours; avoid late-day dosing to minimize insomnia risk 1
Dose Adjustments for Specific Populations
Moderate Renal Impairment (eGFR 30-59 mL/min/1.73 m²)
Reduce to one tablet once daily in the morning only. 1 This is the maximum recommended dose for this population.
Severe Renal Impairment (eGFR 15-29 mL/min/1.73 m²)
Auvelity is not recommended. 1 The pharmacokinetics have not been evaluated in severe renal impairment, and safety cannot be assured.
End-Stage Renal Disease
Avoid Auvelity entirely. 1
Hepatic Impairment
- Mild (Child-Pugh A) or Moderate (Child-Pugh B): No dose adjustment required 1
- Severe (Child-Pugh C): Not recommended 1 — pharmacokinetics have not been studied in this population
CYP2D6 Poor Metabolizers
Reduce to one tablet once daily in the morning. 1 Poor metabolizers have significantly higher dextromethorphan concentrations due to impaired metabolism, necessitating dose reduction to prevent toxicity.
Pre-Treatment Screening Requirements
Before initiating Auvelity, you must: 1
- Assess blood pressure (contraindicated in uncontrolled hypertension)
- Screen for bipolar disorder, mania, or hypomania (risk of precipitating manic episodes)
- Verify no other bupropion-containing products are being used (risk of seizures with excessive bupropion)
- Verify no other dextromethorphan-containing products are being used
Key Contraindications
Absolute contraindications include: 1
- Uncontrolled hypertension
- Seizure disorders (bupropion lowers seizure threshold)
- Current or recent (within 14 days) monoamine oxidase inhibitor use
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
- Concurrent use of other bupropion-containing products
- Anorexia nervosa or bulimia
- Chronic opioid use (dextromethorphan may interfere with opioid efficacy)
Special Populations
Geriatric Patients (≥65 years)
No specific dose adjustment is recommended, though clinical studies did not include sufficient numbers of elderly patients to determine differential responses. 1 Exercise caution due to potential increased sensitivity to CNS effects.
Pediatric Patients
Not recommended. Safety and effectiveness have not been established in pediatric patients. 1 Additionally, bupropion carries a black box warning for increased suicidal thoughts and behaviors in pediatric patients.
Pregnancy and Lactation
- Pregnancy: Use alternative treatment for females planning pregnancy due to potential fetal harm 1
- Lactation: Breastfeeding is not recommended during treatment and for 5 days following the final dose due to potential neurotoxicity risk 1
Clinical Pearls
- Rapid onset: Clinical improvement may be observed as early as week 1, with significant effects by week 2 2, 3
- Avoid fatty meals: High-fat meals significantly increase systemic drug levels 4
- Monitor vital signs: Check blood pressure and heart rate at initiation and regularly thereafter, as slight elevations have been observed 4
- Drug interactions: Bupropion is a CYP2D6 inhibitor; consider interactions with medications metabolized by this pathway (e.g., beta-blockers, certain antidepressants) 5
- Seizure risk: Risk increases with doses exceeding recommendations, history of seizures, eating disorders, or abrupt withdrawal from CNS depressants 1