What are the cheap options for Auvelity (dextromethorphan-bupropion)?

Cost-Effective Options for Auvelity (Dextromethorphan-Bupropion)

The most cost-effective alternative to Auvelity is using separate generic bupropion and over-the-counter dextromethorphan as individual components, though this approach lacks the FDA-approved dosing and formulation of the combination product.

Understanding Auvelity Components

Auvelity is a fixed-dose combination of dextromethorphan (45mg) and bupropion (105mg) approved for major depressive disorder. To understand cost-saving options, we need to examine both components:

Dextromethorphan

• Available over-the-counter as a cough suppressant 1
• Effective dose range for cough: typically 30mg every 6-8 hours
• Maximum cough reflex suppression occurs at 60mg 1
• Available in various forms including syrups, lozenges, and tablets

Bupropion

• Available as generic prescription medication
• Typical cost: $14-$33 for SR formulation (100-400mg daily) 1
• Also available as immediate release and XL formulations

Cost-Saving Options

1. Separate Components Approach

   • Generic bupropion SR (150mg): approximately $14-$33 per month 1
   • OTC dextromethorphan: approximately $5-$10 per month
   • Total estimated cost: $19-$43 per month

2. Generic Bupropion Only

   • Bupropion alone (150-300mg daily): $14-$33 per month 1
   • While not providing the same mechanism as Auvelity, bupropion is an effective antidepressant on its own

3. Patient Assistance Programs

   • Check manufacturer's website for patient assistance programs
   • May provide significant discounts for eligible patients

Important Clinical Considerations

Efficacy Comparison

• Auvelity demonstrated superior efficacy compared to bupropion alone in clinical trials 2
• The dextromethorphan-bupropion combination showed significant reductions in depression scores within two weeks 3
• Response rates at week 6 were 60.5% with dextromethorphan-bupropion versus 40.5% with bupropion alone 2

Safety Considerations

• Using separate components carries risks:
  • Precise dosing of dextromethorphan from OTC products may be difficult
  • The FDA-approved formulation may have different bioavailability
  • Bupropion inhibits CYP2D6, increasing dextromethorphan levels 3
  • This interaction is intentional in Auvelity but may be unpredictable with separate components

Monitoring Requirements

• Blood pressure and heart rate should be monitored regularly, especially during the first 12 weeks 4
• Mental health should be closely watched for changes in mood, behavior, or suicidal thoughts 4

Alternative Antidepressants to Consider

If cost is the primary concern, consider these alternatives:

1. Generic SSRIs

   • Citalopram: $4 per month 1
   • Sertraline: $7-$10 per month 1
   • Fluoxetine: $4-$8 per month 1

2. Other Generic Antidepressants

   • Mirtazapine: $5-$20 per month 1
   • Trazodone: $4-$10 per month 1

Recommendation Algorithm

1. First-line approach for cost-conscious patients:

   • Try generic SSRI (citalopram, sertraline) at $4-$10 per month
   • Monitor for 4-8 weeks for adequate response

2. If first-line ineffective or not tolerated:

   • Consider generic bupropion alone ($14-$33)
   • Monitor for 4-8 weeks for adequate response

3. If second-line ineffective:

   • Consider separate components approach (generic bupropion + OTC dextromethorphan)
   • Discuss with pharmacist for appropriate dosing guidance
   • Monitor closely for side effects and efficacy

4. If all above options fail or are contraindicated:

   • Explore patient assistance programs for branded Auvelity
   • Consider other antidepressant classes based on patient profile

Cautionary Notes

• The separate components approach is not FDA-approved and lacks clinical validation
• Dextromethorphan products often contain additional ingredients that may be problematic with regular use
• Self-medication with dextromethorphan carries risk of misuse or incorrect dosing
• Consultation with a healthcare provider is essential before attempting any alternative approach

Remember that while cost is an important consideration, efficacy and safety should not be compromised when treating major depressive disorder, which carries significant morbidity and mortality risks.