Since<unk>  is metabolized to hydroxybupropion by the enzyme CYP2B6, drug interactions with CYP2B6 inhibitors are possible: this includes such medications as paroxetine, sertraline, norfluoxetine (active metabolite of fluoxetine), diazepam, clopidogrel, and orphenadrine. The expected result is the increase of<unk>  and decrease of hydroxybupropion blood concentration. The reverse effect (decrease of<unk>  and increase of hydroxybupropion) can be expected with CYP2B6 inducers such as carbamazepine, clotrimazole, rifampicin, ritonavir, St John's wort, and phenobarbital. Indeed, carbamazepine decreases exposure to<unk>  by 90% and increases exposure to hydroxybupropion by 94%. Ritonavir, lopinavir/ritonavir, and efavirenz have been shown to decrease levels of<unk>  and/or its metabolites. Ticlopidine and clopidogrel, both potent CYP2B6 inhibitors, have been found to considerably increase<unk>  levels as well as decrease levels of its metabolite hydroxybupropion.<unk>  and its metabolites are inhibitors of CYP2D6, with hydroxybupropion responsible for most of the inhibition. Additionally,<unk>  and its metabolites may decrease expression of CYP2D6 in the liver. The end effect is a significant slowing of the clearance of other drugs metabolized by this enzyme. For instance,<unk>  has been found to increase area-under-the-curve of desipramine, a CYP2D6 substrate, by 5-fold.<unk>  has also been found to increase levels of atomoxetine by 5.1-fold, while decreasing the exposure to its main metabolite by 1.5-fold. As another example, the ratio of dextromethorphan (a drug that is mainly metabolized by CYP2D6) to its major metabolite dextrorphan increased approximately 35-fold when it was administered to people being treated with 300 mg/day<unk> . When people on<unk>  are given MDMA, about 30% increase of exposure to both drugs is observed, with enhanced mood but decreased heart rate effects of MDMA. Interactions with other CYP2D6 substrates, such as metoprolol, imipramine, nortriptyline, venlafaxine, and nebivolol have also been reported. However, in a notable exception,<unk>  does not seem to affect the concentrations of CYP2D6 substrates fluoxetine and paroxetine.<unk>  lowers the seizure threshold, and therefore can potentially interact with other medications that also lower it, such as antipsychotics, tricyclic antidepressants, theophylline, and systemic corticosteroids. The prescribing information recommends minimizing the use of alcohol, since in rare cases<unk>  reduces alcohol tolerance. Caution should be observed when combining<unk>  with a monoamine oxidase inhibitor (MAOI), as it may result in hypertensive crisis.
Bupropion
Atomoxetine
Hydroxybupropion
Entropion
Citalopram
Duloxetine
Dapoxetine
Fluoxetine