Is tics described as an adverse effect of bupropin (voxra)?/nA patient with severe Obsessive Compul

Fråga: Is tics described as an adverse effect of bupropin (voxra)?

A patient with severe Obsessive Compulsive Disorder (OCD) has a few days after institution of bupropion 150 mg/day developed vocal tics and a week later also motorical tics. She also became very talkative but showed no other signs of hypomania.

Now much improved after discontinuation of bupropion treatment and a short course of haloperidol.

Sammanfattning: We found no reports of bupropion causing tics, but worsening of pre-existing tics have been described in patients exposed to the drug.

Svar: Bupropion hydrochloride is a nonselective inhibitor of the dopamine transporters and the norepinephrine transporter and is also an antagonist at neuronal nicotinic acetylcholine receptors (1).

A PubMed search, there are a few case reports about bupropion associated with tics.

Spencer T. et al reported a series of four patients with comorbid ADHD and Tourette Syndrome. Discontinuation of bupropion treatment coincided with an immediate amelioration of worsened tics in all cases (2).

In the Swedish adverse drug reactions register, number of reactions with possible relationship was 438. Among of those, there are reports of 1 dyskinesea and 1 hypomania (3).

There is a speculation that the exacerbation of tics is also mediated through a dopaminergic mechanism. Bupropion, with its stimulant-like structure and weak dopaminergic activity may exacerbate tics through dopaminergic actions.

In addition to that, there are some reports about acute dystonia (4), dyskinesia (5), and ballism (6) induced by bupropion. We recommend this case be reported to the regional adverse drug reaction monitoring center. Dwoskin LP, Rauhut AS, King-Pospisil KA, Bardo MT. Review of the pharmacology and clinical profile of bupropion, an antidepressant and tobacco use cessation agent. CNS Drug Rev 2006;12(3-4):178-207 Spencer T, Biederman J, Steingard R, Wilens T. Bupropion exacerbates tics in children with attention-deficit hyperactivity disorder and Tourette´s syndrome. J Am Acad Child Adolesc Psychiatry 1993;32(1):211-214

Swedis online (2009-11-23)
Detweiler MB, Harpold GJ. Bupropion-induced acute dystonia. Ann Pharmacother 2002;36(2):251-254
Kohen I, Sarcevic A. Mirtazapine in bupropion-induced dyskinesias: a case report. Mov Disord 2006;21(4):584-585

de Graaf L. Ballism associated with bupropion use. Ann Pharmacother 2003;37:302-303