Side Effects of Forfivo XL (bupropion hydrochloride)

Forfivo XL is an extended-release form of bupropion hydrochloride, an antidepressant that impacts brain chemicals involved in nerve communication.

Depression is often linked to an imbalance of neurotransmitters, which serve as chemical messengers in the brain. Forfivo XL works by preventing the reuptake of dopamine, serotonin, and norepinephrine, allowing these neurotransmitters to transmit messages more effectively.

Unlike other antidepressants, Forfivo XL primarily affects dopamine levels, as opposed to selective serotonin reuptake inhibitors (SSRIs) that target serotonin specifically.

Some serious side effects of Forfivo XL include manic episodes, hallucinations, and an increased risk of suicidal thinking and behavior, especially in children and adolescents with depression or other psychiatric disorders.

Forfivo XL may interact negatively with drugs that lower the seizure threshold, such as prochlorperazine, chlorpromazine, and other antipsychotics. Withdrawing from benzodiazepines also increases the risk of seizures.

It is important to avoid combining Forfivo XL with monoamine oxidase inhibitors (MAOIs), as the combination can lead to severe reactions. It is advised to wait at least 14 days between stopping an MAOI and starting Forfivo XL.

Forfivo XL may also interact with warfarin and ritonavir, affecting their actions or elimination processes.

While limited data is available on Forfivo XL’s effects during pregnancy, studies indicate no significant difference in the occurrence of birth defects compared to other antidepressants. However, the use of Forfivo XL during pregnancy should only be considered if the benefits outweigh the potential risks.

If you are breastfeeding, consult your doctor before taking Forfivo XL, as it is secreted in breast milk.

What are the side effects of Forfivo XL?

What are the common side effects of Forfivo XL?

The most common side effects of bupropion include agitation, insomnia, and, in some cases, weight loss. Manic episodes and hallucinations may occur less frequently.

Bupropion can increase the risk of seizures, especially at doses exceeding 450 mg/day or when combined with medications or conditions that lower the seizure threshold.

Antidepressants, including Forfivo XL, may elevate the risk of suicidal thoughts and behavior in children and adolescents with depression. Close monitoring is necessary when starting or changing antidepressant therapy.

What drugs interact with Forfivo XL?

Potential For Other Drugs To Affect Forfivo XL

• Forfivo XL can interact with drugs that inhibit or induce CYP2B6, an enzyme responsible for metabolizing bupropion.
• Concurrent use of Forfivo XL with ticlopidine or clopidogrel is not recommended, as these drugs increase bupropion exposure.
• Forfivo XL’s effectiveness may be reduced when taken with drugs like ritonavir, lopinavir, efavirenz, carbamazepine, phenobarbital, or phenytoin, which induce CYP2B6 metabolism. Dose adjustments may be necessary, but the maximum recommended dose of bupropion should not be exceeded.

Potential For Forfivo XL To Affect Other Drugs

Drugs Metabolized By CYP2D6

• Bupropion and its metabolites inhibit CYP2D6, which can increase the levels of drugs metabolized by this enzyme.
• This interaction may require dose adjustments, particularly for drugs with a narrow therapeutic index, such as certain antidepressants, antipsychotics, beta-blockers, and Type 1C antiarrhythmics.
• Drugs like tamoxifen that require CYP2D6 activation may also be affected. Increased doses may be necessary when using Forfivo XL with these drugs.

Drugs That Lower Seizure Threshold

• Extreme caution should be exercised when simultaneously using Forfivo XL with medications or substances that lower the seizure threshold, including other bupropion products, antipsychotics, antidepressants, theophylline, or corticosteroids.

Dopaminergic Drugs (Levodopa And Amantadine)

• Bupropion, levodopa, and amantadine all have dopamine agonist effects.
• Co-administration of bupropion and levodopa or amantadine should be approached cautiously, as the cumulative dopamine agonist effects can lead to central nervous system toxicity.
• In instances where patients receive both levodopa or amantadine and Forfivo XL, close monitoring is advised.

Use With Alcohol

• Combining alcohol with Forfivo XL treatment may result in adverse neuropsychiatric events or reduced alcohol tolerance.
• Alcohol consumption can enhance the release rate of Forfivo XL, so it is advisable to avoid alcohol during treatment.

Monoamine Oxidase Inhibitors (MAOIs)

• Concurrent use of Forfivo XL and MAOIs is contraindicated due to the increased risk of hypertensive reactions.
• A 14-day interval is necessary between discontinuing an MAOI and starting Forfivo XL.

Drug-Laboratory Test Interactions

• Screening tests for amphetamines may produce false-positive results in patients taking bupropion. Follow-up confirmatory tests can distinguish between bupropion and amphetamines.
• False-positive test results may still occur even after discontinuing bupropion therapy.