From the FDA Drug Label
Consider a reduced dose and/or dosing frequency of bupropion hydrochloride extended-release tablets (XL) in patients with renal impairment (glomerular filtration rate: <90 mL/min). 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)].
A reduced dose and/or dosing frequency of bupropion should be considered in patients on dialysis.
- The starting dose is not explicitly stated in the label for patients on dialysis, but it is recommended to reduce the dose and/or frequency.
- Safety in patients on dialysis is a concern due to the potential accumulation of bupropion and its metabolites, which may increase the risk of adverse reactions. It is essential to monitor closely for adverse reactions that could indicate high bupropion or metabolite exposures 1.
From the Research
Bupropion can be used in patients on dialysis, but a reduced starting dose of 150 mg every 3 days is recommended, as evidenced by a study in 2004 2. This is due to the potential accumulation of the drug's metabolites in renal failure. The medication is primarily metabolized by the liver, but some metabolites are renally excreted and may accumulate in end-stage renal disease. Some key points to consider when prescribing bupropion to patients on dialysis include:
- Starting with a lower dose and monitoring the patient's response closely
- Being aware of the potential for increased side effects, such as seizures, agitation, insomnia, and blood pressure changes
- Scheduling the dose after dialysis on treatment days to maintain consistent blood levels of the medication
- Considering the pharmacokinetics of bupropion and its metabolites in patients with renal impairment, as studied in 2007 3 and 2012 4
- Being mindful of the risk of seizures associated with bupropion use, as reviewed in 1989 5 It's essential to weigh the benefits and risks of using bupropion in patients on dialysis and to closely monitor their response to the medication. The most recent and highest quality study on this topic is from 2012 4, which provides guidance on the use of antidepressants, including bupropion, in patients with chronic kidney disease. However, the specific recommendation for a starting dose of 150 mg every 3 days in patients on dialysis is based on the 2004 study 2. Overall, the use of bupropion in patients on dialysis requires careful consideration and monitoring to minimize the risk of adverse effects and maximize the potential benefits.