Bupropion Contraindications in Seizure Disorders

Contraindications and Risk Factors

The American Gastroenterological Association guidelines state that naltrexone-bupropion ER should be avoided in patients with seizure disorders and used with caution in patients at risk of seizures 1, 2
The 2017 Gastroenterology practical guidelines specify avoidance in patients with "history of seizures, or any condition that predisposes to seizure" 3
Conditions that increase seizure risk include arteriovenous malformation 1, and anorexia nervosa or bulimia, which have a higher seizure incidence documented 3
Metabolic disorders, such as hypoglycemia, hyponatremia, severe hepatic impairment, or hypoxia, can also increase seizure risk 3
Diabetes mellitus treated with oral hypoglycemics or insulin, and use of anorectic drugs, are additional risk factors 2

The National Comprehensive Cancer Network explicitly recommends avoiding bupropion in patients with seizure history or elevated seizure risk, although the specific citation is not provided, the AGA guidelines provide similar recommendations 1, 2

Bupropion reduces the seizure threshold through its effects on the dopaminergic and adrenergic systems, as well as its inhibition of nicotinic acetylcholinergic receptors 4, 5, 6

Brain metastases are a risk factor for seizures with bupropion, according to the National Comprehensive Cancer Network 4, 5, 6
Elevated risk of seizure due to other conditions is also a risk factor for seizures with bupropion 4, 5, 6

The National Comprehensive Cancer Network recommends avoiding bupropion in patients with a history of seizures or elevated seizure risk 4, 5, 6
Consider alternative medications for patients with seizure disorders or risk factors, as recommended by the National Comprehensive Cancer Network 4, 5, 6

The American Gastroenterological Association recommends avoiding bupropion in patients with seizure disorders and using it with caution in patients at risk of seizures 7
The American Diabetes Association states that bupropion is contraindicated in patients with uncontrolled hypertension and/or seizure disorders 8

Untreated hyperthyroidism, particularly when combined with phentermine formulations, is a risk factor for seizures in patients taking bupropion 7

The use of clozapine with bupropion may have additive or synergistic effects on seizure risk, with clozapine alone having a 10% cumulative seizure risk at 3.8 years 7