
Auvelity
Auvelity (dextromethorphan / bupropion) is a newer antidepressant that's taken by mouth. It can work faster than some other antidepressants, but it's not a good choice for people with a history of seizures, eating disorders, severe kidney or liver problems, or alcohol abuse.
What is Auvelity (dextromethorphan / bupropion)?
What is Auvelity (dextromethorphan / bupropion) used for?
- Depression
How Auvelity (dextromethorphan / bupropion) works
Auvelity (dextromethorphan / bupropion) is a combination of two medications:
- Dextromethorphan is an N-methyl-D-aspartate (NMDA) receptor antagonist (meaning it blocks the receptor) and a sigma-1 receptor agonist (meaning it attaches to the receptor). By blocking or activating certain receptors, it's thought that dextromethorphan raises glutamate and monoamine levels in your brain. These chemicals are thought to be involved with boosting your mood.
- Bupropion is thought to raise levels of two mood-boosting chemicals in your brain (norepinephrine and dopamine). It also helps dextromethorphan last longer in your body. The way it works to treat depression isn't fully clear.
Drug facts
| Common Brands | Auvelity |
|---|---|
| Drug Class | Antidepressant |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
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Side effects of Auvelity (dextromethorphan / bupropion)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Dizziness (16%)
- Nausea (13%)
- Headache (8%)
- Diarrhea (7%)
- Drowsiness (7%)
- Dry mouth (6%)
- Sexual problems (e.g., erectile dysfunction, low sex drive; 6%)
- Sweating a lot (5%)
Less Common Side Effects
- Anxiety
- Constipation
- Poor appetite
- Trouble sleeping
- Joint pain
- Feeling tired
- Tingling sensation
- Blurry vision
Auvelity (dextromethorphan / bupropion) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts or behavior
- Seizures
- Manic episodes: very high or low energy, angry or very happy, problems with sleep
- Serotonin syndrome agitation, restlessness, trouble sleeping, feeling confused, fast heart rate, enlarged pupils, trouble controlling muscle movements
The following Auvelity (dextromethorphan / bupropion) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Increase in blood pressure
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Seizures
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Change in sex drive or performance
- Diarrhea
- Dizziness
- Drowsiness
- Dry mouth
- Excessive sweating
- Headache
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Pros and cons of Auvelity (dextromethorphan / bupropion)
Pros
- Works faster to treat depression symptoms compared to other antidepressants
- Can be taken with or without food
- Works well to improve depression symptoms in adults
- Conveniently combines two medications into one tablet
Cons
- Not recommended while pregnant or breastfeeding
- Not studied in children
- Brand only, so might be expensive
- Can interact with many medications
Pharmacist tips for Auvelity (dextromethorphan / bupropion)
- Swallow Auvelity (dextromethorphan / bupropion) tablets whole. Don't crush, chew, or split the tablets because this could damage the medication. The tablets are made to release slowly in your body. Breaking the tablets could lead to side effects, or the medication might not work as well for you.
- Avoid drinking alcohol since Auvelity (dextromethorphan / bupropion) can cause dizziness, and alcohol can make it worse.
- If you already drink alcohol regularly, talk with your provider before starting Auvelity (dextromethorphan / bupropion) to see if you can safely lower the amount of alcohol you drink. While you're recommend to avoid combining alcohol with this medication because of the higher risk of dizziness, stopping alcohol too suddenly can put you at risk for seizures.
- Before stopping any of your medications, talk to your provider first. Stopping certain medications too suddenly can lead to seizures. Some examples include benzodiazepines, antiseizure medications, and sleeping medications (e.g., barbiturates).
- Dizziness is a common side effect of Auvelity (dextromethorphan / bupropion). Don't drive or perform any activities that require you to be alert until you know how Auvelity (dextromethorphan / bupropion) affects you. Take extra care if you're at a higher risk for falls, since this medication can raise your risk of falling.
- Auvelity (dextromethorphan / bupropion) can narrow the angle between the eye's iris and cornea if you naturally have narrow angles and haven't had surgery to correct it. This can damage the optic nerve and lead to permanent vision loss (angle-closure glaucoma). Tell your healthcare provider if you develop sudden eye pain, changes in vision, or swelling or redness in or around the eye.
- If you miss a dose of Auvelity (dextromethorphan / bupropion), wait and take your dose at your next scheduled time. Never take more than 1 tablet of Auvelity (dextromethorphan / bupropion) at a time because this can lead to side effects.
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Risks and warnings for Auvelity (dextromethorphan / bupropion)
Auvelity (dextromethorphan / bupropion) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts or behavior
- Risk factors: Age 24 years or younger
Antidepressant medications, like Auvelity (dextromethorphan / bupropion), can raise the risk of having suicidal thoughts or behavior. The risk is higher for people under the age of 24. Watch for new or worsening depression and suicidal thoughts or behavior. Pay extra attention to your mood, especially during the first few months of treatment or if there's a dose change to your medication. Let your healthcare provider know right away if you notice any unusual changes in your mood or behavior, or if you have thoughts of wanting to harm yourself, while taking this medication.
Seizures
- Risk factors: Taking more Auvelity (dextromethorphan / bupropion) than recommended | History of seizures or eating disorders | Recently quitting alcohol or certain medications | Taking other medications that can cause seizures | Past head trauma or conditions that can cause seizures | Frequent alcohol, sedative, cocaine, or stimulant use | Taking insulin or blood sugar medications
Bupropion, one of the medications in Auvelity (dextromethorphan / bupropion), can raise your risk of seizures. Seizures are unlikely if you take Auvelity (dextromethorphan / bupropion) as directed by your provider. But your risk for seizures goes up if you take more than recommended. Don't take Auvelity (dextromethorphan / bupropion) if you have a history of seizures or conditions that raise your risk of seizures (e.g., head trauma; eating disorders; stroke; recently stopping alcohol use; or take medications like benzodiazepines, barbituates, or seizure medications).
Before you start Auvelity (dextromethorphan / bupropion), let your provider know your medical history and any medications or supplements you're taking. They can check if any of these things put you at higher risk for seizures. Let your caregiver or family members know about the possibility of seizures with Auvelity (dextromethorphan / bupropion), so they can help you if you have a seizure. Stop taking Auvelity (dextromethorphan / bupropion) and tell your provider right away if you think you've had a seizure while on treatment.
High blood pressure
- Risk factors: High blood pressure | Taking other medications that can raise blood pressure
Bupropion can raise your blood pressure. Your risk is higher if you're also taking medications that can raise blood pressure, like nicotine replacement products and monoamine oxidase inhibitors (MAOIs), such as selegiline (Zelapar) and phenelzine (Nardil). That's why it's not recommended to take MAOIs within 14 days of Auvelity (dextromethorphan / bupropion). Check your blood pressure often, and let your healthcare provider know if your blood pressure rises.
Changes in thoughts, mood, or behavior
- Risk factors: Personal or family history of bipolar disorder | Depression or other mental health conditions | Taking more bupropion or dextromethorphan than recommended
Antidepressants, like Auvelity (dextromethorphan / bupropion), can trigger mania or hypomania. This is more likely to happen if you or someone in your family have bipolar disorder. Talk to your healthcare provider right away if you notice unusual changes in your behavior or thoughts. Get medical help right away if you feel extreme happiness, jumpy, irritable, or have racing thoughts.
Some people who’ve taken bupropion or dextromethorphan (especially higher doses of these medications) have experienced serious mental health side effects. Check to see if you're taking other medications that also contain bupropion or dextromethorphan, such as over-the-counter cough medications, so you don't end up taking too much. If you experience symptoms,such as hearing or seeing things that aren't there, confusion, and psychosis, stop taking Auvelity (dextromethorphan / bupropion) right away and get medical help.
In rare cases, dextromethorphan can also cause people to become unresponsive or fall into a coma. Make sure your caregivers are aware of this, so they can find medical help for you if needed.
Serotonin syndrome
- Risk factors: Taking other medications that can affect the serotonin levels in your brain
Serotonin syndrome is a rare, but potentially life-threatening condition where there's too much serotonin active in the brain. Serotonin is one of the chemicals in your brain responsible for your mood. Your risk goes up if you use Auvelity (dextromethorphan / bupropion) with other medications that affect serotonin levels (other antidepressants, certain antinausea medications, triptans, St. John's wort). Symptoms of too much serotonin include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Tell your healthcare provider or get medical help right away if you experience any of these symptoms.
Harm to unborn babies
- Risk factors: Pregnancy
Based on animal studies, Auvelity (dextromethorphan / bupropion) might cause harm to unborn babies when taken during pregnancy. If you're pregnant or thinking about becoming pregnant, talk with your provider about safer options to treat your depression. take this medication. If you become pregnant while taking Auvelity (dextromethorphan / bupropion), let your provider know right away.
Auvelity (dextromethorphan / bupropion) dosage
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 45mg/105mg | 60 tablets | $1,141.26 | $19.02 |
Typical dosage for Auvelity (dextromethorphan / bupropion)
Each tablet of Auvelity contains 45 mg of dextromethorphan and 105 mg of bupropion.
The typical starting dose is 1 tablet by mouth every morning for 3 days. After 3 days, continue with maintenance dose of 1 tablet twice daily (separated by at least 8 hours).
Your dose might differ if you have kidney problems or if you're taking certain medications.
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How much does Auvelity (dextromethorphan / bupropion) cost?
$1,141.26
Auvelity (dextromethorphan / bupropion) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Auvelity (dextromethorphan / bupropion) will not be safe for you to take.
- Have been diagnosed with a seizure disorder
- Current or history of an eating disorder (e.g., anorexia or bulimia)
- Stopping alcohol, benzodiazepines, barbiturates, or antiseizure medications suddenly
- Taking a monoamine oxidase inhibitor (MAOI) or within 14 days of Auvelity (dextromethorphan / bupropion)
What are alternatives to Auvelity (dextromethorphan / bupropion)?
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