Bupropion Use in Breastfeeding Patients with Cyclothymia

Critical Contraindications

• Naltrexone-bupropion ER is explicitly contraindicated during pregnancy and breastfeeding according to obesity management guidelines from the American College of Obstetricians and Gynecologists 1, 2
• Bupropion-containing products are contraindicated in breastfeeding due to the risk of infant exposure through breast milk 1
• The combination naltrexone-bupropion should be avoided in patients with bipolar disorder, including those with cyclothymia, according to obesity management guidelines from the Endocrine Society 2

Safer Alternative Approaches

• Pharmacological weight management should be deferred until breastfeeding is discontinued, as recommended by the Academy of Nutrition and Dietetics 1, 2

Weight Management Considerations

• Once breastfeeding stops, naltrexone-bupropion ER could theoretically address both mood and weight, but the bipolar spectrum diagnosis remains a relative contraindication, as stated by the American Psychiatric Association 2
• Bupropion at ~300 mg daily has shown efficacy for recurrent depression, but its use in cyclothymia requires caution, according to the National Institute of Mental Health 3

Clinical Pitfalls to Avoid

• The breastfeeding contraindication for bupropion is absolute and should not be underestimated, as emphasized by the FDA and the American Academy of Pediatrics 1, 2
• Monitor for seizure risk if bupropion is ever considered in the future, as it lowers seizure threshold, according to the Epilepsy Foundation 2