#特殊劑型：不建議磨粉、管灌藥品

Major depressive disorder (unipolar), Seasonal affective disorder, Smoking cessation
#仿單變更2022

Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor
Bupropion is a relatively weak inhibitor of the neuronal uptake of norepinephrine and dopamine, and does not inhibit monoamine oxidase or the reuptake of serotonin. Metabolite inhibits the reuptake of norepinephrine.

Absorption:
1. Onset of action: 1 to 2 weeks
2. Duration of action: 1 to 2 days
Distribution:
1. Vd: ~20 to 47 L/kg
2. Protein binding: 84%
Metabolism:
Extensively hepatic via CYP2B6 to hydroxybupropion; non-CYP-mediated metabolism to erythrohydrobupropion and threohydrobupropion. Metabolite activity ranges from 20% to 50% potency of bupropion. Bupropion also undergoes oxidation to form the glycine conjugate of meta-chlorobenzoic acid, the major urinary metabolite.
Excretion:
Urine (87%, primarily as metabolites); feces (10%, primarily as metabolites)

1. Hypersensitivity to bupropion or any component of the formulation
2. Seizure disorder
3. History of anorexia/bulimia
4. Patients undergoing abrupt discontinuation of ethanol or sedatives(benzodiazepines, barbiturates, or antiepileptic drugs)
5. Use of MAO inhibitors (concurrently or within 14 days of discontinuing either bupropion or the MAO inhibitor)
6. Initiation of bupropion in a patient receiving linezolid or intravenous methylene blue

Pregnancy Risk Factor C (FDA)

Bupropion and its active metabolites are present in breast milk.
Seizures and sleep disturbances have been reported in breastfeeding infants following bupropion exposure via breast milk.

Common:
Tachycardia, insomnia, headache, agitation, dizziness, diaphoresis, weight loss, xerostomia, constipation, nausea and vomiting, nausea, tremor, blurred vision, nasopharyngitis, pharyngitis, rhinitis
Warnings:
1. Serotonin syndrome: Serotonin syndrome has been reported in patients combining Bupropion and other drugs such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine re-uptake inhibitors (SNRIs). <20220127>

Major depressive disorder (unipolar):
Initial 150 mg once daily in the morning; if tolerated, may increase as early as day 4 of dosing to 300 mg once daily; if no clinical improvement after 2 weeks, may increase to 450 mg once daily
Seasonal affective disorder (SAD):
Initial 150 mg once daily in the morning; if tolerated, may increase after 7 days to 300 mg once daily in the morning
Smoking cessation:
Note: Therapy should begin at least 1 week before target quit date. Target quit dates are generally in the second week of treatment. If patient successfully quits smoking, continue treatment for at least 12 weeks.
(Monotherapy or in combination with nicotine replacement therapy) Initial 150 mg once daily for 3 days; increase to 150 mg twice daily (maximum dose: 300 mg/day).

Limited data available

Use with caution; manufacturer's labeling suggests a reduction in dose and/or frequency be considered but does not provide specific dosing recommendations.

1. Mild impairment (Child-Pugh score 5 to 6): Use with caution; manufacturer's labeling suggests a reduction in dose and/or frequency
2. Moderate to severe impairment, including severe hepatic cirrhosis (Child-Pugh score 7 to 15): Use with extreme caution; maximum 150 mg every other day