Drug interactions
Bupropion + Nefazodone
Severity: Major
Bupropion and Nefazodone: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Nefazodone and its metabolites inhibit CYP3A4 and may alter bupropion metabolism, with additional effects on CYP2D6 from bupropion. Bupropion toxicity is dose-related and includes lowered seizure threshold, agitation and insomnia. The combination also carries additive risk of neuropsychiatric effects.
What this interaction means in plain words
Bupropion and Nefazodone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Altered hepatic metabolism of bupropion and its active metabolites, together with additive pharmacodynamic effects on seizure threshold.
What to do
Prefer an alternative antidepressant combination; if used, keep the bupropion dose as low as possible and monitor for seizures, agitation and tremor. Avoid in patients with seizure risk factors.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Bupropion
- Bupropion + Isocarboxazid Contraindicated
- Bupropion + Linezolid Contraindicated
- Bupropion + Phenelzine Contraindicated
- Bupropion + Rasagiline Contraindicated
- Bupropion + Selegiline Contraindicated
- Bupropion + Selegiline transdermal Contraindicated
Frequently asked questions
Can I take Bupropion with Nefazodone?
MediHelp rates the interaction as major. Bupropion and Nefazodone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Nefazodone and its metabolites inhibit CYP3A4 and may alter bupropion metabolism, with additional effects on CYP2D6 from bupropion. Bupropion toxicity is dose-related and includes lowered seizure threshold, agitation and insomnia. The combination also carries additive risk of neuropsychiatric effects.
How serious is the interaction between Bupropion and Nefazodone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer an alternative antidepressant combination; if used, keep the bupropion dose as low as possible and monitor for seizures, agitation and tremor. Avoid in patients with seizure risk factors.
What other medicines interact with Bupropion?
MediHelp also lists interactions of Bupropion with, for example, Isocarboxazid, Linezolid, Phenelzine. The full list is on the Bupropion page.
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