| Major depressive disorder in adults (label). View labelExact | Recommended starting regimen: one tablet once daily in the morning; after 3 days, increase to one tablet twice daily given at least 8 hours apart (label). | Combination antidepressant pairing dextromethorphan (NMDA receptor antagonist and sigma-1 receptor agonist) with bupropion, which inhibits CYP2D6 to increase dextromethorphan exposure; used for major depressive disorder. | CYP2D6, CYP2B6 | Steady-state mean 22 h | No | | - Suicidal thoughts and behaviors monitoring during initiation and dose changes (label).
- Blood pressure and heart rate monitoring, especially with concomitant stimulants or noradrenergic agents (label/clinical).
- Seizure risk screening (history, eating disorder risk, abrupt sedative/alcohol withdrawal) (label/clinical).
- Serotonin syndrome monitoring when combined with serotonergic agents (label/clinical).
- Mania/hypomania monitoring in bipolar-spectrum illness (clinical).
| No | 2026-02-23 |
|---|
bupropionAdjunctive therapyBrands: WELLBUTRIN | MDD; seasonal affective disorder; smoking cessation (SR). View labelExact | XL: start 150 mg qAM for 3–7 days, increase to 300 mg qAM; may increase to 450 mg qAM if needed. | Norepinephrine–dopamine reuptake inhibitor (NDRI). | CYP2B6 | Steady-state mean 21 h | No | — | - Blood pressure at baseline and after dose changes, especially when nicotine replacement is used.
- Seizure risk factors (eating disorder history, alcohol/benzodiazepine withdrawal, electrolyte disturbances) before initiation and at follow-up.
- Sleep and anxiety during early titration; dose timing and titration speed are common levers for tolerability.
- Mood elevation or agitation in bipolar-spectrum illness; coordinate prevention plans via the bipolar disorder hub.
- Medication list review to ensure only one bupropion-containing product is active (to reduce accidental dose escalation across brands).
| No | 2026-02-12 |
|---|
| Major depressive disorder; generalized anxiety disorder; diabetic peripheral neuropathic pain; fibromyalgia; chronic musculoskeletal pain. View labelExact | Major depressive disorder (clinical depression) and generalized anxiety disorder: typical initiation is 30 mg once daily for one week for tolerability, then 60 mg once daily. If needed, 90–120 mg/day is sometimes used (divide when >60 mg/day), though antidepressant benefit often plateaus beyond 60 mg/day. | Serotonin-norepinephrine reuptake inhibitor (SNRI). | CYP1A2, CYP2D6 | Single-dose mean 12 h; Single-dose range 8–17 h; Steady-state mean 12 h | No | — | - Blood pressure and heart rate at baseline and periodically, especially during titration and at higher doses.
- Liver-injury symptoms (jaundice, dark urine, abdominal pain, pruritus), particularly in patients with alcohol use disorder or hepatic disease; LFTs are obtained when clinically indicated.
- Sodium in older adults or diuretic users if symptoms suggest hyponatremia (confusion, fatigue, falls).
- Medication reconciliation for serotonergic combinations and for CYP2D6 substrates (TCAs, antipsychotics, beta-blockers, tamoxifen).
| No | 2025-10-05 |
|---|
| Major depressive disorder. View labelExact | Initiate 10 mg once daily; increase to 20 mg once daily after at least 7 days if tolerated.[label_vortioxetine] | Multimodal antidepressant: SERT inhibition plus 5-HT receptor modulation. | CYP2D6, CYP3A4, CYP2C19 | Single-dose mean 66 h; Steady-state mean 66 h | No | — | - Suicidality and psychiatric activation during initiation and dose changes, especially in younger adults.[label_vortioxetine]
- Nausea and early GI tolerability during the first 1–2 weeks; supportive care and dosing time adjustments can prevent premature discontinuation.
- Sodium in older adults or patients on diuretics if symptoms suggest hyponatremia (confusion, fatigue, falls).[label_vortioxetine]
- Medication reconciliation for CYP2D6 inhibitors/inducers that can shift exposure and tolerability.[label_vortioxetine]
- Mood elevation or mixed features in bipolar-spectrum illness; coordinate monitoring plans via the bipolar disorder hub.
| No | 2026-02-22 |
|---|