Bupropion with Propranolol Interaction Details

Brand Names Associated with Bupropion

Brand Names Associated with Propranolol

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Mar 06, 2024

Interaction Effect

Increased exposure of CYP2D6 substrates

Interaction Summary

Use caution with concurrent administration of buPROPion (a CYP2D6 inhibitor) and a CYP2D6 substrate as this may increase the exposure of the CYP2D6 substrate[1][2]. Coadministration of buPROPion and a single dose of desipramine (a CYP2D6 substrate) resulted in a 2-fold, 5-fold, and 2-fold increase in desipramine Cmax, AUC, and t(1/2), respectively [2]. The CYP2D6 substrate should be initiated at the lower end of the dose range when given with buPROPion. If buPROPion is added to an existing regimen with a CYP2D6 substrate, consider decreasing the CYP2D6 substrate dose, especially if it has a narrow therapeutic index [1][2]. Monitor for toxicity during coadministration.

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concurrent administration of buPROPion (a CYP2D6 inhibitor) and a CYP2D6 substrate may increase the exposure of the CYP2D6 substrate and should be undertaken with caution. When given with buPROPion the CYP2D6 substrate should be initiated at the lower end of the dose range. If buPROPion is added to an existing regimen with a CYP2D6 substrate, consider decreasing the CYP2D6 substrate dose, especially if it has a narrow therapeutic index[1][2]. Monitor for toxicity during coadministration.

Mechanism Of Interaction

Inhibition of CYP2D6-mediated metabolism by buPROPion and its hydroxybupropion metabolite

Literature Reports

A) Coadministration of buPROPion 150 mg twice daily and a single dose of desipramine 50 mg (a CYP2D6 substrate) in healthy volunteers who were extensive 2D6 metabolizers (n=15) resulted in a 2-fold, 5-fold, and 2-fold increase in desipramine Cmax, AUC, and t(1/2), respectively. The effect persisted for 7 days following the last dose of buPROPion [2].

References

1 ) Product Information: CONTRAVE(R) oral extended-release tablets, naltrexone HCl and bupropion HCl oral extended-release tablets. Orexigen Therapeutics, Inc. (per manufacturer), La Jolla, CA, 2014.

2 ) Product Information: WELLBUTRIN SR(R) oral sustained-release tablets, bupropion HCl oral sustained-release tablets. GlaxoSmithKline (per FDA), Research Triangle Park, NC, 2013.

Bupropion Overview

• 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.

Propranolol Overview

• Propranolol is used to treat high blood pressure, irregular heart rhythms, pheochromocytoma (tumor on a small gland near the kidneys), certain types of tremor, and hypertrophic subaortic stenosis (a heart muscle disease). It is also used to prevent angina (chest pain), migraine headaches, and to improve survival after a heart attack. Propranolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.