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Does Bupropion Cause Nor-epinephrine Levels To Drop?

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Posted on Mon, 11 May 2015
Question: Does bupropion initially cause norepinephrine levels to drop similar to other reuptake inhibitors like SSRIs? I began taking bupropion and a rash developed over my body. Could my temporarily lowered norepinephrine levels just be exacerbating a skin allergy that will go away as the levels eventually increase?
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
rash is common side effetc of bupropion

Detailed Answer:
Hello,

Thanks for writing to us.

Mechanism of action of bupropion is not exactly established. But it does not drop level of norepinephrine in synapse.

Rash is common side effect of bupropion and can occur in 5 -10 % of patients taking bupropion.

And if you are already suffering from allergy it is difficult to take judgement that it is exacerbation of allergy or rash due to bupropion. In that liaison of dermatologist and psychiatrist opinion to be done.

In any case if your rash is started after starting bupropion, you should immediately consult your treating doctor for examination and evaluation.

Rash may go away gradually as you become tolerant and adapted to the drug and in some cases there is need of stopping the drug.

Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (7 minutes later)
Thanks for the answer. The study I read actually said that it decreased the firing rate : The suppressant effect of clonidine on NE neuronal firing was significantly attenuated in rats treated with bupropion for 14 days, indicating a desensitization of alpha2-adrenoceptors. In the VTA, neither 2 nor 14 days of bupropion administration altered the firing and burst activity of dopamine neurons. These results indicate that bupropion, unlike 5-HT reuptake inhibitors, promptly increased 5-HT neuronal activity, due to early desensitization of the 5-HT1A autoreceptor. The gradual recovery of neuronal firing of NE neurons, due to the desensitization of alpha2-adrenoceptors, in the presence of the sustained increase in 5-HT neuronal firing, may explain in part the delayed onset of action of bupropion in major depression. Sooooooo is there a chance that the initial drop in the neuronal firing rate of NE is the cause of my rash, and that it will get better as the firing rate gradually recovers?
doctor
Answered by Dr. Chintan Solanki (6 hours later)
Brief Answer:
you misinterpreted the sentence

Detailed Answer:
Hello,

Thanks for technical question.I hope you have some medical background and are ware of neuronal anatomy and chemistry.

"The suppressant effect of clonidine on NE neuronal firing was significantly attenuated in rats treated with bupropion for 14 days, indicating a desensitization of alpha2-adrenoceptors."

Alpha 2 adrenoreceptors are autoreceptors for norepinephrine. Desensitization of the same increase the norepinephrine in synapse(space between two neuronal cells where all neurochemical reaction take place). Suppressant effect of clonidine on NE was attenuated this also means NE firing increases.

"bupropion, unlike 5-HT reuptake inhibitors, promptly increased 5-HT neuronal activity, due to early desensitization of the 5-HT1A autoreceptor. The gradual recovery of neuronal firing of NE neurons, due to the desensitization of alpha2-adrenoceptors, in the presence of the sustained increase in 5-HT neuronal firing, may explain in part the delayed onset of action of bupropion in major depression. "

This action is responsible for effect in depression. Gradual recovery of neuronal firing of NE neurons means NE neurons reduce the secretion of NE as there is enough level of NE in synapse due to desensitization of alpha auto receptors(these receptors are responsible of uptake of NE back in neurons). By no mean above sentence implies that it reduces norepinephrine level. It is very difficult for a lay man to understand that neuronal chemistry.

But yes if rash is due to bupropion, it is likely due to idiopathic unknown mechanism and it can recover on its own when not severe.It is clinical judgement of a doctor that drug should be continued or not on basis of severity of rash.

Hope this answer clear your doubts.Feel free to discuss further if you have more doubts/query.

take care.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Does Bupropion Cause Nor-epinephrine Levels To Drop?

Brief Answer: rash is common side effetc of bupropion Detailed Answer: Hello, Thanks for writing to us. Mechanism of action of bupropion is not exactly established. But it does not drop level of norepinephrine in synapse. Rash is common side effect of bupropion and can occur in 5 -10 % of patients taking bupropion. And if you are already suffering from allergy it is difficult to take judgement that it is exacerbation of allergy or rash due to bupropion. In that liaison of dermatologist and psychiatrist opinion to be done. In any case if your rash is started after starting bupropion, you should immediately consult your treating doctor for examination and evaluation. Rash may go away gradually as you become tolerant and adapted to the drug and in some cases there is need of stopping the drug. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.