Drug interactions
Bupropion + Perhexiline
Severity: Major
Bupropion and Perhexiline: major interaction.
Last updated
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
Perhexiline is cleared mainly by CYP2D6 and has a narrow therapeutic index, so strong CYP2D6 inhibition by bupropion can raise concentrations substantially. This risks hepatotoxicity, peripheral neuropathy, hypoglycemia and ataxia.
What this interaction means in plain words
Bupropion and Perhexiline 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
Bupropion inhibits CYP2D6, the principal route of perhexiline elimination.
What to do
Avoid the combination if possible; otherwise reduce the perhexiline dose and monitor plasma perhexiline concentrations and liver function.
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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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 Perhexiline?
MediHelp rates the interaction as major. Bupropion and Perhexiline 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. Perhexiline is cleared mainly by CYP2D6 and has a narrow therapeutic index, so strong CYP2D6 inhibition by bupropion can raise concentrations substantially. This risks hepatotoxicity, peripheral neuropathy, hypoglycemia and ataxia.
How serious is the interaction between Bupropion and Perhexiline?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination if possible; otherwise reduce the perhexiline dose and monitor plasma perhexiline concentrations and liver function.
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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