Aplenzin XR (bupropion hydrobromide/HBr)

  • MOA: not completely understood (-NIH). Norepinephrine/dopamine-reuptake inhibitor (NDRI) that exerts its pharmacological effects by weakly inhibiting the enzymes involved in the uptake of the neurotransmitters norepinephrine and dopamine from the synaptic cleft. –DrugBank
  • Indications: treatment for major depressive disorder (MDD), seasonal affective disorder (SAD), and as an aid to smoking cessation. When used in combination with naltrexone as the marketed product ContraveⓇ, bupropion is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults. Bupropion is also used off-label as a first-line treatment in patients with ADHD. –DrugBank
  • Dosing Forms/Indications: available in the following strengths: 174 mg, 348 mg, and 522 mg.

Quick Pearls

Typical dosing for Aplenzin (bupropion hydrobromide)

  • Depression: The typical starting dose is 174 mg by mouth once daily. After 4 days, your provider might raise your dose to the target of 348 mg by mouth once daily.
  • Seasonal affective disorder (SAD): The typical starting dose is 174 mg by mouth once daily. After 1 week, your provider might raise your dose to the target of 348 mg by mouth once daily. Treatment is usually started in the autumn season before your SAD symptoms begin and it’s continued through the winter season. Your provider will likely have you stop taking Aplenzin (bupropion hydrobromide) in the early spring.
  • Your dose may differ if you have kidney or liver problems.

–GoodRx

Pros 

  • Using a “salt” derivative may make bupropion more tolerable
  • Fewer sexual s/e and less likely to gain weight
  • Non-schedule and less symptomatic than with stimulants

Cons

  • Aplenzin XR is brand, coverage is difficult/$$$$ maybe document if there are side-effects with bupropion. Usually, I can get coverage if I document the problems with previous medications.
  • NO short-acting version so if you’re treating ADHD you may have to go back to generics…
  • The same side effects apply with other forms of bupropion; SZ risks, SI warnings r/t antidepressants, contraindicated with eating disorders, limit or avoid ETOH.
  • Takes weeks to get the full effect but usually sooner than with SSRIs.

Additional Information 

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