bupropion hydrochloride extended release (Forfivo XL)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: Bupropion hydrochloride extended release
BRAND NAME: Forfivo XL
DRUG CLASS AND MECHANISM: Bupropion hydrochloride is an antidepressant medication that affects chemicals within the brain that nerves use to send messages to each other. (Forfivo XL is an extended release form of bupropion hydrochloride.) Chemical messengers are called neurotransmitters. Many experts believe that depression is caused by an imbalance among the amounts of neurotransmitters that are released. Nerves may recycle neurotransmitters by a process referred to as reuptake in which the released neurotransmitters are taken up and reused (released again) by the nerves. Bupropion works by inhibiting the reuptake of dopamine, serotonin, and norepinephrine by the nerves after they have been released, an action that results in more dopamine, serotonin, and norepinephrine to transmit messages to other nerves. Bupropion is unique and unlike other antidepressants in that its major effect is on dopamine, an effect that is not shared by the related selective serotonin reuptake inhibitors or SSRIs (for example, paroxetine [Paxil], fluoxetine [Prozac], sertraline [Zoloft]) or the tricyclic antidepressants or TCAs (for example, amitriptyline [Elavil, Endep], imipramine [Tofranil], desipramine [Norpramin]). The FDA approved Forfivo in December 1985.
GENERIC AVAILABLE: Yes (other extended release formulations of bupropion)
STORAGE: Tablets should be kept at room temperature, 15 C to 25 C (59 F to 77 F).
PRESCRIBED FOR: Bupropion is used for the management of major depression.
DOSING: Bupropion is given as 450 mg once daily without regards to meals. It is given to patients receiving 300 mg of another bupropion formulation daily for at least 2 weeks and require 450 mg daily. Those receiving 450 mg daily of another bupropion formulation can be switched directly to Forfivo.
DRUG INTERACTIONS: Bupropion should be used cautiously in patients receiving drugs that reduce the threshold for seizures. Such drugs include prochlorperazine (Compazine), chlorpromazine (Thorazine), and other antipsychotic medications of the phenothiazine class. Additionally, persons who are withdrawing from benzodiazepines (for example, diazepam [Valium], alprazolam [Xanax]) are at increased risk for seizures.
Carbamazepine (Tegretol) may reduce the effect of bupropion by reducing its blood concentration. Monamine oxidase inhibitors should not be combined with bupropion because of the risk of severe reactions. At least 14 days should elapse between discontinuation of an monoamine oxidase inhibitor and initiation of bupropion. bupropion may affect the action of warfarin (Coumadin).
Ritonavir (Norvir) may increase the breakdown and elimination of bupropion. In some studies ritonavir reduced the concentration of bupropion in the body by 22% to 66%.
PREGNANCY: There are no adequate studies of bupropion in pregnant women. In one study, there was no difference between bupropion and other antidepressants in the occurrence of birth defects. Bupropion should only be used in pregnancy if the benefit outweighs the potential risk.
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