Bupropion XL single tablet only goes to 300mg and some people require higher dosages, without wanting to worry about taking more meds so here comes Forfivo XL. Its side-effect profile and risks are still similar to bupropion. Although not mentioned (like many other medications), start low and titrate/go up slowly so the brand isn’t first-line but still approved for disorders. I’ve had patients with palpitations, intrusive thoughts, irritability, etc. at the low dosages though it should be self-limiting…
As the brand name implies, the daily dosage is 450 mg (for = 4, fiv = 5, o = 0) once daily. Other dosage forms of bupropion are recommended to be used to titrate up to this dose. A 450-mg per-day dose should only be used in patients who are receiving 300 mg daily of another form of bupropion for at least 2 weeks and who need an increased dosage. Patients currently being treated with other bupropion products at 450 mg per day can be switched to an equivalent 450 mg per day dosage. –UF Health
Mechanism of Action: Bupropion is a 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, therefore prolonging their duration of action within the neuronal synapse and the downstream effects of these neurotransmitters. –DrugBank
Indications: Forfivo XL is a prescription medicine used to treat the symptoms of Major Depression Disorder and Seasonal Affective Disorder. Forfivo XL may be used alone or with other medications. Forfivo XL belongs to a class of drugs called Antidepressants, Dopamine Reuptake Inhibitors; Antidepressants, and Other; Smoking Cessation Aids. –RX List
Dosing Forms: One tablet (450 mg) of FORFIVO XL should be taken once daily without regard to meals. FORFIVO XL should be swallowed whole and not crushed, divided, or chewed. -RX List
What Other Important Information Should I Know About Forfivo XL?
Activation of mania/hypomania: Depression may be the early symptom of bipolar disorder. Using Forfivo XL can trigger mania/hypomania if you have bipolar disorder. Tell your healthcare provider all of your symptoms, and if you or a family member has ever had depression, suicidal thoughts or actions, bipolar disorder, or other mental health problems. Your healthcare provider may check you for bipolar disorder.
Seizures: There is a chance of having a seizure (convulsion, fit) with Forfivo XL, especially in people:
- with certain medical problems.
- who take certain medicines.
If you have a seizure while taking Forfivo XL, stop taking the tablets and call your healthcare provider right away. Do not take Forfivo XL again if you have a seizure.
High blood pressure (hypertension): Some people get high blood pressure that can be severe while taking Forfivo XL. The chance of high blood pressure may be higher if you also use nicotine replacement therapy (such as a nicotine patch) to help you stop smoking.
Severe allergic reactions: Some people have severe allergic reactions to Forfivo XL. Stop taking Forfivo XL and call your healthcare provider right away if you get a rash, itching, hives, fever, swollen lymph glands, painful sores in the mouth or around the eyes, swelling of the lips or tongue, chest pain, or trouble breathing. These could be signs of a serious allergic reaction.
Unusual thoughts or behaviors: Some patients have unusual thoughts or behaviors while taking Forfivo XL, including delusions (believing you are someone else), hallucinations (seeing or hearing things that are not there), paranoia (feeling that people are against you), or feeling confused. If this happens to you, call your healthcare provider.
Pros:
- Bupropion is still a great alternative to the typical antidepressants, weight neutral/loss, decrease cravings, and low sexual s/e.
- Brands are normally better tolerated, I have patients with s/e with generics but won’t have the same issue with brands. The problem most of the time is coverage, but at least companies are offering more coupons/savings…
Cons:
- Not a clear conversion from other bupropion generics/brands or if it’ll make a difference other than the pill count. That’s literally what the rep explained but overall brands are more PO tolerated.
- In general, with bupropion, you have to take ETOH, liver issues, eating disorders, or SZ history into consideration. Even at the lower dosage, I’ve had patients report “blacking out” with just 1-2 drinks. It’s one of the reasons why brands may be important to reduce s/e or possibly a contraindication.
Offical Medication Website: Forfivo (bupropion hydrochloride)
