Systematic review of preclinical, clinical, and post-marketing evidence of bupropion misuse potential

ABSTRACT

Background: Bupropion is a substituted cathinone compound widely used as a first line or add-on treatment for depression, smoking cessation, and more recently in combination with naltrexone for weight loss. As abuse of synthetic cathinone compounds has received more attention in recent years, concern about the misuse potential of bupropion has grown as well.

Objectives: We review bupropion pharmacology and assessments of misuse potential including preclinical evidence, human studies, and post-marketing surveillance of bupropion misuse.

Methods: This review reports the results of a systematic review of publications evaluating the potential for bupropion to be misused. Publications were identified using PubMed and Medline through Ovid® as well as iterative bibliographic searches. A summary of data from informal sources of information including substance-user experience from online forum entries is included.

Results: Preclinical evidence demonstrates some potential for misuse based on psychomotor, discrimination, self-administration, and conditioned place preference tasks. However, this potential is less than that of commonly misused stimulants. Studies in human populations similarly indicate that bupropion shares interoceptive effects with other stimulants, but lacks some key reinforcing effects of other stimulants. In the real-world setting, misuse of bupropion occurs, but is uncommon. Adverse effects of bupropion misuse are frequently cited as significant barriers to obtaining any desired interoceptive effect.

Conclusions: While bupropion demonstrates some potential for misuse, pharmacological differences from other structurally-related stimulants limit bupropion’s reinforcing effects. Without additional data indicating susceptibility of specific populations to bupropion misuse, there is no empirical data suggesting a need to modify bupropion prescribing patterns.

KEYWORDS:

• Bupropion
• cathinone
• amphetamine
• central nervous system stimulants
• prescription drug misuse

Disclosure

Dr. Naglich is employed by the Department of Veterans Affairs and reports no conflicts of interest.

Dr. Brown reports receipt of research grants from Forrest, and Otsuka, and an honorarium from Genentech within the past 36 months.

Dr. Adinoff reports no conflicts of interest. He has received funding from the National Institute on Drug Abuse and he has received salary from Taylor & Francis Inc. for services as Editor-in-Chief of the American Journal of Drug and Alcohol Abuse. Honorarium has been received from the American Academy of Addiction Psychiatry and John Peter Smith Hospital in Ft. Worth, TX within the past 36 months.

Additional information

Funding

This material is based upon work supported by the Office of Academic Affiliations, Department of Veterans Affairs, and resources and the use of facilities at the North Texas Veteran’s Affairs Healthcare System, Dallas, Texas. The views expressed in this article do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.