Is there an interaction between bupropion (Bupropion SR), zopiclone, and pramipexole?

Potential Drug Interactions Between Bupropion SR, Zopiclone, and Pramipexole

There is a potential for clinically significant interactions between bupropion SR, zopiclone, and pramipexole, particularly regarding increased risk of neuropsychiatric effects and sleep disturbances. 1

Neuropsychiatric Interaction Concerns

Bupropion SR and pramipexole both affect dopaminergic pathways, creating potential for additive effects:

• Bupropion functions as a dopamine/norepinephrine reuptake inhibitor 1
• Pramipexole is a dopamine agonist that affects similar pathways
• This combination may increase risk of:
  • Neuropsychiatric symptoms including mood changes 1
  • Increased risk of seizures (bupropion lowers seizure threshold) 2, 1
  • Potential for exacerbated insomnia 1

Sleep-Related Interactions

The addition of zopiclone to this combination raises additional concerns:

• Bupropion commonly causes insomnia as a side effect 2
• Zopiclone is metabolized through multiple CYP pathways 3
• Bupropion is a CYP inhibitor which could potentially increase zopiclone levels 4
• The combination may lead to:
  • Unpredictable sleep patterns
  • Increased daytime sedation
  • Potential for increased neuropsychiatric effects

Cardiovascular Considerations

• Bupropion can increase blood pressure and heart rate 1
• Monitoring of cardiovascular parameters is recommended when using bupropion 1
• No significant cardiovascular interactions have been specifically documented between these three medications

Management Recommendations

When these medications must be used together:

1. Start with lower doses of both medications and titrate slowly 1
2. Monitor closely for:
   • Sleep disturbances
   • Neuropsychiatric symptoms
   • Seizure activity
   • Changes in blood pressure and heart rate
3. Consider alternative medications if side effects emerge

Specific Precautions

• Bupropion has a known seizure risk of approximately 0.1% 1
• The risk increases in patients with:
  • Prior seizure history
  • Structural brain lesions
  • Alcohol abuse
  • Medications that lower seizure threshold 2
• Zopiclone may have fewer drug interactions than traditional benzodiazepines, but still requires caution when combined with medications affecting the central nervous system 3

While no studies specifically examine the three-drug combination, the overlapping mechanisms of action and side effect profiles suggest caution is warranted when using these medications together.