Side Effects of Auvelity (Dextromethorphan and Bupropion)
The most common side effects of Auvelity include dizziness, nausea, headache, diarrhea, somnolence, dry mouth, sexual dysfunction, hyperhidrosis, anxiety, constipation, decreased appetite, and insomnia. 1
Common Side Effects
Auvelity combines dextromethorphan and bupropion, with many of its side effects stemming from the bupropion component. The most frequently reported adverse effects include:
Neurological effects:
- Dizziness
- Headache
- Somnolence (drowsiness)
- Insomnia
Gastrointestinal effects:
- Nausea
- Dry mouth
- Diarrhea
- Constipation
- Decreased appetite
Other common effects:
- Sexual dysfunction
- Hyperhidrosis (excessive sweating)
- Anxiety
Serious Side Effects and Warnings
Seizure Risk
Seizures are a serious potential side effect of Auvelity, primarily due to the bupropion component. The risk increases at higher doses 1. Patients with a history of seizures, brain injuries, or conditions that lower seizure threshold should use this medication with extreme caution or avoid it altogether 2.
Psychiatric Effects
Like all antidepressants, Auvelity carries a boxed warning regarding increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults 1. The American College of Physicians recommends close monitoring for:
- Suicidal ideation
- Anxiety
- Agitation
- Mood changes 3
Cardiovascular Effects
Bupropion can cause increased blood pressure and heart rate, requiring regular monitoring, especially in patients with pre-existing cardiovascular conditions 3.
Contraindications
Auvelity should not be used in patients with:
- Seizure disorders
- Current use of MAO inhibitors
- Uncontrolled hypertension
- Conditions that lower seizure threshold
- Anorexia or bulimia nervosa
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs 4
Special Populations
Renal Impairment
For patients with moderate to severe renal impairment, the bupropion dose should be reduced by 50%, and it should be avoided in end-stage renal disease 4, 3.
Hepatic Impairment
In patients with moderate to severe hepatic impairment, bupropion dosing should not exceed one tablet daily 4, 3.
Elderly Patients
Lower starting doses should be considered for elderly patients due to increased risk of adverse effects 3.
Drug Interactions
Auvelity has significant drug interaction potential:
- MAO inhibitors: Contraindicated due to risk of hypertensive crisis
- Opioids: May reduce efficacy of opioid analgesics or precipitate withdrawal reactions due to naltrexone component 4
- Alcohol: Limit or avoid alcohol during treatment 2
- Medications that lower seizure threshold: Increased seizure risk 2
Clinical Efficacy Context
Despite these side effects, clinical trials have shown Auvelity to be effective for major depressive disorder with rapid onset of action. In long-term studies, remission rates approached 70%, while response rates were greater than 80% 5. This favorable efficacy profile may outweigh the side effect burden for many patients with depression.
Monitoring Recommendations
- Regular monitoring of blood pressure and heart rate
- Close observation for neuropsychiatric symptoms, especially during the first few months of treatment
- Monitoring for seizure risk factors
- Gradual dose titration to minimize side effects
Discontinuation
When discontinuing Auvelity, gradual tapering is recommended to minimize withdrawal symptoms, which may include neuropsychiatric symptoms, insomnia, headache, and mood changes 3.