Summary

The interaction between leuprolide and bupropion is generally considered low risk, but requires monitoring due to potential additive effects on mood and neurological symptoms. Both medications can affect neurotransmitter levels and may influence seizure threshold in susceptible patients.

Introduction

Leuprolide is a gonadotropin-releasing hormone (GnRH) agonist primarily used to treat hormone-sensitive conditions such as prostate cancer, endometriosis, and uterine fibroids by suppressing testosterone and estrogen production. Bupropion is an atypical antidepressant and smoking cessation aid that works as a norepinephrine-dopamine reuptake inhibitor (NDRI), commonly prescribed for major depressive disorder and seasonal affective disorder.

Mechanism of Interaction

The interaction mechanism between leuprolide and bupropion involves potential additive effects on the central nervous system. Leuprolide's suppression of sex hormones can lead to mood changes, depression, and cognitive effects due to hormonal fluctuations. Bupropion affects dopamine and norepinephrine reuptake, which can influence mood regulation. Additionally, both medications may lower seizure threshold through different pathways - leuprolide through hormonal changes and bupropion through its direct effects on neurotransmitter systems.

Risks and Symptoms

The primary clinical risks include increased potential for mood disturbances, particularly depression or anxiety, when leuprolide-induced hormonal suppression combines with bupropion's neurochemical effects. There may be an additive risk of seizures in predisposed patients, as both medications can lower seizure threshold. Patients may also experience enhanced neuropsychiatric side effects such as confusion, agitation, or sleep disturbances. The interaction significance is generally considered minor to moderate, but individual patient factors may increase risk.

Management and Precautions

Monitor patients closely for mood changes, particularly during leuprolide initiation or dose adjustments. Assess seizure risk factors before starting combination therapy and counsel patients about seizure precautions. Regular psychiatric evaluation may be warranted, especially in patients with pre-existing mental health conditions. Consider dose adjustments of bupropion if significant mood symptoms develop. Ensure adequate patient education about potential side effects and when to seek medical attention. Healthcare providers should maintain open communication between oncology, psychiatry, and primary care teams when managing these patients.

Bupropion interactions with food and lifestyle

Alcohol: Bupropion may lower the seizure threshold, and concurrent alcohol use can further increase seizure risk. Patients should avoid or limit alcohol consumption while taking bupropion. Sudden discontinuation of alcohol in patients with alcohol dependence may also increase seizure risk. Smoking cessation: While bupropion is used for smoking cessation, patients should be aware that nicotine withdrawal itself can affect seizure threshold. Close monitoring is recommended during the quit process. High-fat meals: Taking bupropion with high-fat meals may increase drug absorption and potentially increase side effects. Consider taking with light meals or on an empty stomach as tolerated.