Bupropion-Warfarin Combination: A Serious Complication
A 55-year-old male was on treatment for dysthymic disorder (DSM IV TR) since 12 years. He was a heavy smoker. The treatment was mainly with psychotherapy, with periods of antidepressants off and on. He was mostly on bupropion, in doses ranging from 150 mg/ day to 300 mg/day. He responded well to treatment, had few depressive symptoms intermittently, and his smoking had decreased to about 6-8 cigarettes a day. A year back, he developed DVT, at which time, the dose of bupropion was 300 mg/day. He was put on warfarin and the desired level of INR, that is, 2-3, was achieved. At this time, the surgeon did not know that the patient was taking bupropion 300 mg/day. After a couple of weeks, when the patient informed him of this, bupropion was abruptly stopped. The subsequent blood test showed an alarming INR level of 8.0. The patient was under observation, and the surgeon put him back on bupropion, 300 mg/day. The INR returned to the desired level, with no complication. The warfarin was stopped after DVT resolved. The patient remained free of depression and so, bupropion was gradually tapered off.