160 - Dextromethorphan for Depression? Analyzing Data for Auvelity® in Major Depressive Disorder

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 31 January 2023

⏱️ 45 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we discuss the evidence, safety, and place in therapy of Auvelity® (dextromethorphan-bupropion), a newly approved antidepressant with a unique mechanism of action and interesting pharmacokinetic considerations.

Key Concepts

Auvelity® (bupropion-dextromethorphan) was FDA approved in 2022 for major depressive disorder (MDD). The bupropion component inhibits CYP2D6 metabolism and increases serum concentrations of dextromethorphan. The proposed mechanism of benefit in MDD is via dextromethorphan (as an NMDA antagonist) and possibly with bupropion (as a dopamine/norepinephrine reuptake inhibitor).
Although the bupropion component in Auvelity® is being used for its drug interaction, the dose is a therapeutic dose and carries several warnings and precautions, including the risk of seizure and hypertension.
In short (6-week) clinical trials, Auvelity® improved depression symptoms quickly (within 1-2 weeks), which is faster than many other antidepressants. Auvelity® is associated with dizziness, anxiety, hyperhidrosis, nausea, headache, diarrhea, and dry mouth.
As a CYP2D6 inhibitor, the bupropion component of Auvelity® will cause drug interactions with many other medications, including some antidepressants, antipsychotics, and opioid analgesics (among others).

References

Iosifescu DV, Jones A, O'Gorman C, et al. Efficacy and Safety of AXS-05 (Dextromethorphan-Bupropion) in Patients With Major Depressive Disorder: A Phase 3 Randomized Clinical Trial (GEMINI). J Clin Psychiatry. 2022;83(4):21m14345. Published 2022 May 30. doi:10.4088/JCP.21m14345
Tabuteau H, Jones A, Anderson A, Jacobson M, Iosifescu DV. Effect of AXS-05 (Dextromethorphan-Bupropion) in Major Depressive Disorder: A Randomized Double-Blind Controlled Trial. Am J Psychiatry. 2022;179(7):490-499. doi:10.1176/appi.ajp.21080800
Kotlyar M, Brauer LH, Tracy TS, et al. Inhibition of CYP2D6 activity by bupropion. J Clin Psychopharmacol. 2005;25(3):226-229. doi:10.1097/01.jcp.0000162805.46453.e3

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not professional
0:22.4	advice and should not be used in lieu of obtaining advice from a qualified health care provider.
0:27.2	And now on to the show.
0:31.2	Welcome to Helix Talk episode 160. I'm your co-host, Dr. Kane. Unfortunately, Dr. Patel
0:36.7	can't be with us today, but I am so excited
0:39.3	to announce a special guest that we have here today, Dr. Roberta Dume. I'll let her introduce
0:44.4	herself, but it's so special for her to be on this podcast because she's actually an alumni of
0:48.8	our FarmD program. It is now a faculty member at the college. So Dr. Dumay, would you mind
0:53.6	introducing yourself?
0:55.2	Hi, thank you so much for having me again. I am faculty here at RFU and I graduated way back in
1:01.6	2017 from our program, working with the college now as a clinical pharmacist and clinical faculty.
1:08.5	And my clinical site is at the North Chicago VA. And I specialize in
1:12.0	psychiatric pharmacy currently covering our inpatient psychiatric unit there. Thank you so much for having me.
1:17.3	So Dr. Dume, we've brought you on to the episode because the title of today's episode is
1:21.5	Dexteranthoraphane for depression, analyzing data for Avelity and major depressive disorder. So we're talking about a new
1:29.0	drug called brand name Avelity, which is a combination of dexter, methorophane, and bupropion.
1:34.7	And it's not what you think. When I started learning about this new medication, Dr. Dume,
1:38.5	I thought all of the magic was in that bupropion. But as we'll talk about, that dexter methorphine is actually doing something
1:44.3	really surprising that we'll get into.
1:46.4	Well, let's start with kind of a probably very typical patient case that maybe you wouldn't
	...

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