Safety Considerations for Bupropion Use in Patients with History of Substance Use Disorder

Critical Risk Factors

A history of prior overdose substantially increases future overdose risk and is a marker for elevated risk of both opioid-related complications and potential suicide attempts, according to the Annual Review of Medicine 1, 2, 3
A history of substance use disorder, particularly alcohol and opioids, is a major risk factor for both overdose and addiction-related complications, as reported by the Annual Review of Medicine 1, 2, 3, 4

Before initiating treatment, conduct a thorough risk assessment, including current alcohol use patterns and quantity, validated screening with Drug Abuse Screening Test (DAST) and Alcohol Use Disorders Identification Test (AUDIT), and assessment for concurrent substance use, as recommended by the MMWR Recommendations and Reports 1, 2, 5, 6
Provide comprehensive counseling on the absolute necessity to minimize or avoid alcohol while taking bupropion, increased risks when combining bupropion with alcohol or other substances, and warning signs requiring immediate discontinuation, according to the Annual Review of Medicine 1, 2
Implement frequent clinical follow-up, re-evaluating more frequently than every 3 months, given the patient's high-risk profile, and monitor for early warning signs of serious problems, including sedation, mood changes, or difficulty controlling medication use, as recommended by the MMWR Recommendations and Reports 1, 2, 5, 6, 7

If the patient is actively using alcohol heavily or unable to commit to minimizing alcohol use, bupropion should not be initiated, and alternative treatments, such as addressing alcohol use disorder first with appropriate treatment, should be considered, as recommended by the American family physician and MMWR Recommendations and Reports 5, 6, 8