Bupropion Use in Cirrhosis

Monitoring and Precautions

Patients with any degree of cirrhosis require intensive monitoring, including assessment for hepatic encephalopathy at baseline and with each dose adjustment, as psychoactive medications increase risk of altered mental status in advanced cirrhosis 1
Monitoring for seizure risk is necessary, as bupropion lowers seizure threshold, and cirrhotic patients may have increased susceptibility due to metabolic derangements 2
Concomitant medications that interact with serotonin metabolism (SSRIs, SNRIs, tricyclic antidepressants) should be avoided, as these further lower seizure threshold 2

The Clinical and Molecular Hepatology guidelines suggest considering alternative antidepressants with more predictable pharmacokinetics in cirrhosis, such as medications with minimal hepatic metabolism and shorter half-lives 2