From the Guidelines
Bupropion (Wellbutrin) generally does not require dose adjustment in patients with temporary acute kidney injury. The primary reason for this is that bupropion is mainly metabolized by the liver, with a minimal amount excreted unchanged in the urine 1. However, it's crucial to exercise clinical judgment, especially in cases of severe acute kidney injury, where the clearance of bupropion's metabolites, such as hydroxybupropion, might be reduced, potentially leading to increased side effects like seizures, agitation, insomnia, or headaches. Key considerations include:
- Monitoring patients closely for adverse effects
- Temporarily reducing the dose if side effects occur until renal function improves
- Being cautious in patients with both kidney injury and hepatic impairment, as this combination would significantly affect bupropion clearance. Given the information from the study on naltrexone-bupropion ER, which contains bupropion, it is reasonable to maintain the standard dosing of bupropion in patients with temporary acute kidney injury, with careful monitoring for potential side effects 1.
From the FDA Drug Label
Consider reducing the dose and/or frequency of bupropion hydrochloride extended-release tablets (XL) in patients with renal impairment (glomerular filtration rate less than 90 mL/min) [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)]. Bupropion and its metabolites are cleared renally and may accumulate in such patients to a greater extent than usual. Monitor closely for adverse reactions that could indicate high bupropion or metabolite exposures [see Dosage and Administration (2.7) and Clinical Pharmacology (12.3)].
Bupropion may require renal adjustment in patients with temporary acute kidney injury. The dose and/or frequency of bupropion hydrochloride extended-release tablets (XL) should be considered for reduction in patients with renal impairment, including those with temporary acute kidney injury, as bupropion and its metabolites are cleared renally and may accumulate in such patients. Monitoring for adverse reactions is recommended 2.
From the Research
Bupropion and Renal Adjustment
- Bupropion (Wellbutrin) is a medication that requires consideration of renal function in patients with kidney impairment, as its pharmacokinetics can be affected by renal dysfunction 3, 4.
- In patients with temporary acute kidney injury, the need for renal adjustment of bupropion is not explicitly stated in the provided studies, but it can be inferred that renal impairment may affect the drug's pharmacokinetics.
Pharmacokinetics of Bupropion in Renal Impairment
- A study published in the British Journal of Clinical Pharmacology found that bupropion's area under the curve (AUC) was 126% higher, and its clearance (CL/F) was 63% lower in patients with renal impairment compared to healthy subjects 3.
- Another study published in Nephron Clinical Practice found that the pharmacokinetics of bupropion and its metabolites were similar to those in individuals with normal renal function, but the metabolites demonstrated increased areas under the curve, indicating accumulation in haemodialysis patients 4.
Acute Kidney Injury and Renal Recovery
- Acute kidney injury (AKI) is a syndrome that can lead to multi-organ dysfunction, and its incidence rate is increasing 5.
- Renal recovery after AKI is an important goal, and defining renal recovery can be challenging due to the limitations of tests available to assess renal function 6.
- Risk factors for non-recovery of AKI include age, chronic kidney disease (CKD), comorbidity, higher severity of AKI, and acute disease scores 6.
Implications for Bupropion Dosing
- The studies suggest that bupropion's pharmacokinetics can be affected by renal impairment, and dosage adjustments may be necessary in patients with renal dysfunction 3, 4.
- However, the exact dosing recommendations for patients with temporary acute kidney injury are not provided in the studies, and further research is needed to determine the optimal dosing strategy in this population.