ADHD Nonstimulants: Bupropion (Antidepressants)

00:00 Now let's take a look at bupropion.

00:02 It's marketed as Wellbutrin.

00:04 Now, bupropion increases both the norepinephrine and the dopamine that's available because it inhibits the norepinephrine and the dopamine transporters.

00:13 Now, anytime you Hibbett those, remember you have extra in that synaptic cleft makes it more available to the client's brain.

00:19 Now a patient taking bupropion, they'll experience a modest efficacy in decreasing hyperactivity and aggressive behavior.

00:27 So if that's a primary concern for your client, you're probably going to look at a different type of medication.

00:32 But the client will experience less fatigue.

00:36 They'll have a slight increased resting diastolic blood pressure.

00:39 So keep an eye on that.

00:40 And they will have increased body temperature.

00:44 Now there are some adverse effects and they kind of go along with other medications.

00:48 The patient could become more irritable.

00:50 They might not feel like eating.

00:51 Some patients actually enjoy that.

00:53 They may have difficulty with insomnia.

00:55 They might develop some motor tics.

00:57 This also has a decreased seizure threshold.

01:00 So you're going to watch that very carefully with someone who has a history.

01:04 They might have tachycardia extra diaphoresis or sweating.

01:07 And they may experience weight loss due to the anorexia.

01:12 Now the contraindications.

01:13 Again they go right along with the adverse effects we just talked about.

01:17 So like we discussed, if someone has a seizure disorder or any condition that increases their risk of seizure, this would be contraindicated.

01:24 You shouldn't prescribe bupropion.

01:26 Now if they're hypersensitive to any component of the formulation, then again you shouldn't use it if they already have an eating disorder, rather anorexia nervosa or bulimia. This is not a choice for them.

01:40 Now, if the patients are undergoing an abrupt discontinuation of alcohol, benzos, barbiturates or anti-seizure drugs do not start on bupropion again.

01:50 Maois. We all know they don't play well with any other medications or hardly any other.

01:55 So you want a 14 day window of their last dose of Maui before they would take bupropion. Another unusual contraindication, but one you want to be aware of is the initiation in patients who are receiving LD or IV methylene blue.

02:11 Now finally, bupropion should be used in caution in patients with cardiovascular disease or a history of hypertension.

02:18 You want to monitor those vital signs closely.

02:21 So as you're getting ready to consider this medication before you prescribe it, please consider these things.

02:27 Make sure you've ruled out any contraindicated conditions.

02:30 Inform the parents or the guardians as appropriate of the risk of suicidal ideation.

02:35 Now take a look at the Drug Interactions database because bupropion has significant drug interactions with other medications.

02:42 And also you might even consider an ECG before you start the medication when you're prescribing bupropion.

02:49 The formulation that's available are oral tablets that are immediate release or extended release. You're going to start the medication or this prescription at a low dose for the immediate release.

02:59 Typically, it's two doses a day.

03:02 For the extended release, it's typically one dose daily.

03:05 Now, you can titrate this every 1 to 2 weeks with the clients.

03:09 And it's important that they not take a drug holiday.

03:12 Now your monitoring and responsibility includes regular face to face monitoring of your patients, having conversation with them and doing an assessment.

03:21 You want to watch for any activation of bipolar disorder and or suicidal ideation.

03:27 Keep an eye on their vital signs, their heart rate, their blood pressure, monitor their body weight, and also closely watch their renal and hepatic function.

03:35 Now, when you're discontinuing bupropion, make sure you taper it so you avoid the severe withdrawal effects, and it may take up to 4 to 6 months for you to taper this medication. If the patient has been taking bupropion for a long time.