AdultPediatricGeriatricDosage Forms & Strengths dextromethorphan/bupropion tablet, extended-release 45mg/105mg Major Depressive Disorders Indicated for major depressive disorder (MDD) 1 tablet PO qDay in AM for 3 days, then increase to 1 tablet BID given at least 8 hr apart Maximum recommended dose: 1 tablet BID; do not exceed 2 doses/24 hr Dosage Modifications Renal impairment Mild (eGFR ≥60 mL/min/1.73 m2): No dose adjustment required Moderate (eGFR 30-59 mL/min/1.73 m2): 1 tablet PO qAM (do not increase initial dose) Severe (eGFR 15-29 mL/min/1.73 m2): Not recommended Hepatic impairment Mild or moderate (Child-Pugh A or B): No dose adjustment required Severe (Child-Pugh C): Not recommended (not evaluated) Poor CYP2D6 metabolizers or coadministration with CYP2D6 inhibitors 1 tablet PO qAM (do not increase initial dose) Switching to or from MOAI antidepressant At least 14 days must elapse between discontinuing an MAOI and initiating dextromethorphan/bupropion Conversely, at least 14 days must be allowed after stopping dextromethorphan/bupropion before starting an MAOI antidepressant Dosing Considerations Not for use during pregnancy; use alternate antidepressant for females planning to become pregnant Screen patients for bipolar disorder, mania, or hypomania before initiating Screen for other medications containing bupropion and dextromethorphan Assess blood pressure, and monitor periodically during treatment Safety and efficacy not establishedClinical trials did not include adults aged ≥65 years to determine if they respond differently from younger adultsInteraction CheckerEnter a drug name and dextromethorphan/bupropionNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (11)eliglustatbupropion increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.isocarboxazidisocarboxazid and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropionisocarboxazid and dextromethorphan both increase serotonin levels. Contraindicated.phenelzinephenelzine and dextromethorphan both increase serotonin levels. Contraindicated.phenelzine and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropionpimozidebupropion will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Both bupropion and hydroxybupropion (major metabolite) are considered strong CYP2D6 inhibitors; additionally, bupropion and pimozide lower seizure thresholdprocarbazineprocarbazine and dextromethorphan both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.rasagilinerasagiline and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropionrasagiline and dextromethorphan both increase serotonin levels. Contraindicated. Risk of psychosis episodes or bizarre behavior.safinamidedextromethorphan, safinamide. Other (see comment). Contraindicated. Comment: Coadministration of MAOIs and dextromethorphan has been reported to cause episodes of psychosis or bizarre behavior.selegilineselegiline and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropionselegilineselegiline and dextromethorphan both increase serotonin levels. Contraindicated.selegiline transdermalselegiline transdermal and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropiontranylcyprominetranylcypromine and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropiontranylcypromine and dextromethorphan both increase serotonin levels. Contraindicated.Serious - Use Alternative (52)abametapirabametapir will increase the level or effect of bupropion by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP2B6 substrates. If not feasible, avoid use of abametapir.amitriptylineamitriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.amoxapineamoxapine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.buspironebuspirone and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.caffeinecaffeine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.chlorpromazinechlorpromazine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.citalopramcitalopram and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.clomipramineclomipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.bupropion will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.clozapineclozapine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.desipraminedesipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.cyclobenzaprinebupropion and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.desvenlafaxinedextromethorphan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.doxepindoxepin and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.duloxetineduloxetine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.duloxetine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.duloxetine will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.escitalopramescitalopram increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.escitalopram and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.fexinidazolefexinidazole will decrease the level or effect of bupropion by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. Coadministration may decrease plasma concentrations of CYP2B6 substrates owing to fexinidazole inducing CYP2B6.fluoxetinefluoxetine will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.fluoxetine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.fluoxetinefluoxetine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.fluvoxaminefluvoxamine increases toxicity of bupropion by Other (see comment). Avoid or Use Alternate Drug. Comment: May lower seizure threshold; keep bupropion dose as low as possible.fluvoxamine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.grapefruitgrapefruit will increase the level or effect of dextromethorphan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.iobenguane I 131bupropion will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.imipramineimipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.levomilnacipranlevomilnacipran and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.linezolidbupropion, linezolid. serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.linezolid and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.lofepraminelofepramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.lorcaserinbupropion and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.lorcaserindextromethorphan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.maprotilinemaprotiline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.memantinememantine, dextromethorphan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.meperidinedextromethorphan and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.methylene bluemethylene blue and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.bupropion and methylene blue both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.metoclopramide intranasalbupropion will increase the level or effect of metoclopramide intranasal by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Concurrent use of metoclopramide intranasal and strong CYP2D6 inhibitors is not recommended since the metoclopramide intranasal dose cannot be adjusted.milnacipranmilnacipran and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.milnacipranmilnacipran increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.nefazodonenefazodone increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.nefazodone and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.nortriptylinenortriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.olopatadine intranasalbupropion and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. ozanimodozanimod increases toxicity of bupropion by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.paroxetineparoxetine will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.bupropion will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.paroxetine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.paroxetine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.protriptylineprotriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.tedizolidtedizolid, bupropion. Either increases levels of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.selegiline transdermalselegiline transdermal and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.sertralinesertraline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.St John's Wortdextromethorphan and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.theophyllinetheophylline increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.thioridazinebupropion will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.trazodonetrazodone increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.trazodone and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.trimipraminetrimipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.venlafaxinevenlafaxine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.venlafaxinevenlafaxine will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.venlafaxine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.vilazodonedextromethorphan, vilazodone. Either increases toxicity of the other by serotonin levels.