Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
Inhibits norepinephrine and dopamine reuptake and acts as a noncompetitive antagonist at nicotinic acetylcholine receptors, enhancing catecholaminergic neurotransmission and aiding smoking cessation.
Major depressive disorder (MDD), seasonal affective disorder (SAD), smoking cessation (nicotine dependence)
Neuropathic pain, weight loss, attention deficit hyperactivity disorder (ADHD), migraine prophylaxis, methamphetamine dependence, selective serotonin reuptake inhibitor (SSRI)-associated sexual dysfunction, cognitive enhancement and fatigue in multiple sclerosis (MS), post-stroke apathy
Immediate-release (IR), sustained-release (SR), extended-release (XL) tablets (75 mg, 100 mg, 150 mg, 200 mg)
150 mg p.o. daily (SR or XL), titrating as clinically appropriate
150–400 mg/day depending on formulation
Half-life ~21 hours; metabolized primarily via CYP2B6; steady state in ~8 days
Insomnia, headache, dry mouth, nausea, anxiety, tremor, weight loss
Seizures (dose-dependent risk), hypertensive episodes, hypersensitivity reactions
Monitor for seizure risk factors, blood pressure, mood changes, and suicidality
Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with MDD and other psychiatric disorders
Bupropion lowers the seizure threshold, particularly at higher doses, and is contraindicated in patients with seizure disorders or eating disorders such as bulimia nervosa and anorexia nervosa. It is generally activating and may benefit patients with fatigue or hypersomnia. It may enhance motivation and reduce fatigue in traumatic brain injury (TBI) or multiple sclerosis (MS) when seizure risk is low. In Parkinson’s disease (PD), bupropion can improve depressive symptoms but should be used cautiously due to potential interactions with dopaminergic medications. Elderly patients may require dose adjustments due to increased sensitivity to side effects such as insomnia or agitation.