The Efficacy and Toxicity of Bupropion in the Elderly

Bupropion is an antidepressant with excellent tolerability and fe to side f!ffects or drug interactions. These characteristics suite it ioellfo r use both in the elderly and in the medically ill. Huwever, early reports ofseirures with bupropion therapy in patients with bulimia limited its use. The pharmacology, tdJicacy, toxicity, and side dftct profile qfboth the immediate release (IR) and the recently available sustained release(SR)jOrmulations ofbupropion are reviewed. Bupropion S R is associated with a reduced seizure incidence (0. /%) compared to that finmd with the IR formulation (0.4%). Recent reports, however, demonstrate that the half-lif« qf bupropion is prolonged in the elderly and that the elderly accumulate bupropion metabolites. Potential toxic effects, including seizures and psychosis, may result from high bupropion plasma levels and the accumulation ofbupropion metabolites in the elderly or in those with impaired renal or liver function. Clinical reports in the elderlydemonstrate that lower (75-225 mgjday) doses ofbupropion are assuciatedioithfe ioersidedftcts and equal efficacy to thatfou nd with higher duses. Bupropion is a good antidepressant choicejOr the elderly and the medically ill, provided additional precautions, including the use ofloio doses, are taken. Bupropionshould either be avoided orbe usedwith extreme caution in anyone who is at increased risk ofseizuresor who has a history qf'psychosis oran eating disorder. (Suggested Keywords, Ind ex Medi cus MeSH : Bupropion, Geriatric Psychiatry,Psychoses, S ubstance-I nduced, Seizures, Depression, Pharmacokinetics, Antidepressiue Agents, Psychogeriatrics, Psychopharmacology)