Bupropion with St John's Wort 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
Decreased buPROPion plasma concentrations and/or increased risk of dopaminergic side effects (eg, dystonia)
Interaction Summary
Concomitant use of buPROPion and St John's wort may decrease buPROPion and hydroxybupropion exposure[1]. In a systematic review of studies, concomitant use with St John's wort resulted in an increase in buPROPion clearance of 20% with a St. John's wort product containing hyperforin dosage of 40 mg/day [2]. Concomitant treatment may also increase the risk of dopaminergic side effects, such as dystonia. A 58-year-old female experienced prolonged orofacial dystonia following treatment with buPROPion and St John's wort [3]. The risk of interactions cannot be excluded even for low-dose hyperforin St. John’s wort products, however the use of products that result in a dose of not more than 1 mg hyperforin per day may minimize the risk of interactions [2].
Severity
Moderate
Onset
Delayed
Evidence
Established
How To Manage Interaction
Concomitant use of buPROPion and St John's wort may decrease buPROPion and hydroxybupropion exposure[1] and/or increase the risk of dopaminergic side effects, such as dystonia [3]. The risk of interactions cannot be excluded even for low-dose hyperforin St. John’s wort products, however the use of products that result in a dose of not more than 1 mg hyperforin per day may minimize the risk of interactions [2].
Mechanism Of Interaction
Increased buPROPion clearance by St John's wort
Literature Reports
A) In a systematic review of studies of pharmacokinetic interactions involving St John's Wort, concomitant use with buPROPion in 1 study (N=18) resulted in an increase in buPROPion clearance of 20% with a product containing hyperforin dosage of 40 mg/day[2].
B) A 58-year-old female experienced prolonged orofacial dystonia following treatment with buPROPion and St John's Wort. The patient used St John's wort 300 mg daily for several years. Relevant medical history included left-sided Bell palsy, which resolved 37 years prior. There was no familial history of movement disorders. Four days after starting buPROPion 150 mg daily, the patient experienced dystonic movements of the right side of her face, neck and arm for a duration of 2 hours. During these episodic spasms, the patient's eyes would roll back into her head and she could not communicate. The episodes recurred every 3 to 4 minutes and lasted about 45 seconds. However, in between the spasms, her neurologic examination was normal. Blood work revealed subclinical hypothyroidism, which was treated with thyroxine. The patient was diagnosed with acute facial dystonia secondary to buPROPion and treated with IV chlorpheniramine, procyclidine and diazepam, which lessoned the frequency of spasms but not the duration of the spasms. A week later, she was discharged on oral chlorpheniramine, procyclidine and diazepam. Two weeks later, the frequency of spasms lessoned further, but the orofacial dystonia persisted. Carbamazepine 400 mg twice daily was added to her therapy after treatment failure with sodium valproate 800 mg twice daily. All her medications were gradually discontinued. Over a period of 5 months, the dystonia completely resolved. The combination is hypothesized to cause additive serotonin-induced stimulation of dopaminergic signals, thereby potentiating dopaminergic side effects. However, the exact mechanism is unknown [3].
References
1 ) Product Information: ZYBAN(R) oral sustained release tablets, bupropion HCl oral sustained release tablets. GlaxoSmithKline (per FDA), Research Triangle Park, NC, 2016.
2 ) Chrubasik-Hausmann S, Vlachojannis J, & McLachlan AJ: Understanding drug interactions with St John's wort (Hypericum perforatum L.): impact of hyperforin content. J Pharm Pharmacol 2019; 71(1):129-138.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
3 ) Milton JC & Abdulla A: Prolonged oro-facial dystonia in a 58 year old female following therapy with bupropion and St John's Wort. Br J Clin Pharmacol 2007; 64(5):717-718.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
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.
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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.