Auvelity
Combination product
Pronunciation: dex-troe-meth-OR-fan and byoo-PROE-pee-on (aw-VEL-i-tee)
What it isDextromethorphan (NMDA antagonist, sigma-1 agonist) combined with bupropion; major depressive disorder.
Why this oneNon-monoaminergic mechanism; bupropion's CYP2D6 block boosts dextromethorphan, and it beats bupropion alone.
What limits itBupropion's seizure risk and contraindications carry over; serotonin syndrome with other serotonergic drugs; brand-only, costly.
Pearls
- Start once daily × 3 days, then twice daily.
- Strong CYP2D6 inhibition raises other 2D6 substrates.
- Also improves Alzheimer agitation and delays its relapse.
- Not recommended in pregnancy.
A velvety Dexter
Components (2)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder (MDD) | Adults | 45 mg/105 mg QD (morning) | 45 mg/105 mg BID (≥8 h apart) from day 4 | 45 mg/105 mg BID (2 doses/day) |
| Agitation associated with dementia due to Alzheimer's disease | Adults | 30 mg/105 mg QD (morning) | 30 mg/105 mg BID on day 8; then 45 mg/105 mg BID on day 15 (≥8 h apart) | 45 mg/105 mg BID (2 doses/day) |
Titration MDD: increase to BID on day 4. Alzheimer's agitation: increase on day 8, then day 15 based on tolerability
Renal Moderate impairment (eGFR 30-59): max 45 mg/105 mg QD; not recommended in severe (eGFR 15-29)
Hepatic No adjustment for mild/moderate (Child-Pugh A/B); not recommended in severe (Child-Pugh C)
Not indicated as an as-needed (prn) treatment for agitation associated with Alzheimer's dementia; separate BID doses by at least 8 hours
Instructions
- Administer with or without food
- Swallow tablets whole; do not crush, divide, or chew
- Do not exceed two doses within the same day
- At least 14 days between an MAOI and AUVELITY in either direction
- CYP2D6 poor metabolizers or with strong CYP2D6 inhibitors: max 45 mg/105 mg QD
Available strengths
- ER tab 30/105, 45/105 mg
Contraindications
- Seizure disorder
- Current or prior diagnosis of bulimia or anorexia nervosa
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
- Use with an MAOI, or within 14 days of stopping an MAOI (risk of hypertensive crisis and serotonin syndrome); includes linezolid and IV methylene blue
Cautions
- Seizure (dose-related; from bupropion)
- Increased blood pressure and hypertension
- Activation of mania or hypomania; screen for bipolar
- Psychosis and other neuropsychiatric reactions
- Angle-closure glaucoma
- Dizziness (fall risk)
- Serotonin syndrome (with SSRIs/TCAs; dextromethorphan component)
- Embryo-fetal toxicity
- Hyponatremia (SIADH)
Adverse reactions
- MDD: dizziness, headache, diarrhea, somnolence, dry mouth, sexual dysfunction, hyperhidrosis
- Alzheimer's agitation: dizziness, dyspepsia
Pregnancy May cause fetal harm based on animal studies; not recommended in pregnancy; discontinue if pregnant
Lactation Bupropion and metabolites present in human milk; breastfeeding not recommended during treatment and for 5 days after final dose (neurotoxicity concern)
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 30/105 mg | ER tab | 30 qd | — | not offered | |
| 45/105 mg | ER tab | 30 qd | — | $596.93 | not offered |
Clinical profile
Defining liabilitySeizure risk, dizziness and CYP2D6/serotonergic interactions
Part D rank #418.
Self-check
- What dementia-related indication is listed for dextromethorphan–bupropion?
Agitation in Alzheimer dementia. - What boxed psychiatric warning applies?
Suicidal thoughts and behaviors.