Switch medication from bupropion to nortriptyline.[1]
[2]
Stop bupropion
- Day 1: Stop bupropion.
- bupropion can be stopped abruptly for every dosage.[3]
Start nortriptyline
- Day 1: start nortriptyline in a low dosage of 25 mg/day.
- Day 8: increase nortriptyline to a dosage of 50 mg/day.
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- Bupropion slows the metabolism of nortriptyline via CYP2D6.
- The concomitant use of bupropion and tricyclic antidepressants (TCAs) may potentiate the risk of seizures. These agents are all epileptogenic and may have additive effects on the seizure threshold.
-
- Plasma monitoring for TCA's is advisable, because of plasma-reponse relations, genetic polymorphism and under or overdosing.[4]
- ↑ Switches are based on literature references on this page and expert opinions of the authors. The authors have used pharmacokinetic and receptor affinity properties to determine the switch schedules
- ↑ Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
- ↑ Multidisciplinair document Afbouwen Overige Antidepressiva 2023
- ↑ (dutch) monografie.org tricyclische-antidepressiva
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Stop bupropion 
Start nortriptyline
More information