Bupropion with Carbimazole Interaction Details
Brand Names Associated with Bupropion
- Aplenzin®
- Budeprion® SR
- Budeprion® XL
- Buproban®
- Bupropion
- Forfivo® XL
- Wellbutrin®
- Wellbutrin® SR
- Wellbutrin® XL
- Zyban®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 06, 2024
Interaction Effect
An increased risk of hepatotoxicity
Interaction Summary
Clinicians should be aware of the possibility of acute liver insult induced by buPROPion given concurrently with other hepatotoxic drugs, such as carbimazole[1].
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor patient for signs and symptoms of acute hepatotoxicity and measure liver function tests (LFTs).
Mechanism Of Interaction
Unknown
Literature Reports
A) A case has been reported of fatal liver failure possibly associated with concurrent use of buPROPion and carbimazole. A 41-year-old Chinese male was being treated with carbimazole and propranolol for 5 years. A 10-day course of buPROPion was prescribed for smoking cessation. Ten weeks after completing the course of buPROPion therapy he presented to the hospital with severe jaundice, nausea, dyspepsia, lethargy, and epigastric discomfort lasting for 5 days. His carbimazole and propranolol were discontinued. His liver enzymes were all increased (total bilirubin 29 mg/dL or 496 mcmol/L), alkaline phosphatase 138 U/L, alanine aminotransferase 674 U/L, and aspartate aminotransferase 429 U/L. He was transferred to the liver transplant unit 10 days post admission because of deterioration of renal function. Upon arrival he had grade I encephalophathy with ascites. His liver enzymes continued to increase. He was diagnosed with disseminated intravascular coagulation. A liver biopsy was suggestive of drug-induced hepatic cholestasis. The patient's status continued to decline and on day 13 he developed coagulopathy with massive intraabdominal, rectal, and oral bleeding. The patient died on day 14 due to fulminant liver failure complicated by coagulopathy, pulmonary hemorrhage, and pulmonary edema. The exact mechanism of drug-induced liver toxicity in the presence of a possible drug interaction cannot be confirmed. It is essential, however, to recognize this serious adverse effect in patients receiving concurrent treatment with carbimazole and buPROPion [1].
References
1 ) Ai-Leng K, Lai-San T, Kang-Hoe L, et al: Acute liver failure with concurrent bupropion and carbimazole therapy. Ann Pharmacother 2003; 37:220-223.
Bupropion Overview
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Bupropion (Aplenzin, Wellbutrin, Wellbutrin SR, Wellbutrin XL) is used to treat depression. Bupropion (Aplenzin, Wellbutrin XL) is also used to treat seasonal affective disorder (SAD; episodes of depression that occur at the same time each year [usually in the fall and winter but rarely may occur in the spring or summer months]). Bupropion (Zyban) is used to help people stop smoking. Bupropion is in a class of medications called antidepressants. It works by increasing certain types of activity in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.