A 24-year-old woman presents to the primary care clinic seeking assistance to quit smoking. She also reports a 4-month history of persistently low mood, decreased energy, and feelings of worthlessness. Her medical history is significant for active bulimia nervosa, characterized by episodes of binge eating followed by self-induced vomiting three times a week. Her vital signs are within normal limits, and her BMI is 22 kg/m². The physician is considering a pharmacological intervention that can simultaneously target her depressive symptoms and aid in smoking cessation. Which of the following medications is absolutely contraindicated in this patient?
- AFluoxetine
- BMirtazapine
- BupropionAnswer
- DSertraline
- EVenlafaxine
Answer
Bupropion
Bupropion is an atypical antidepressant (a norepinephrine-dopamine reuptake inhibitor) frequently utilized for both major depressive disorder and smoking cessation. However, it is absolutely contraindicated in patients with a current or prior diagnosis of bulimia nervosa or anorexia nervosa. Patients with eating disorders, particularly those who engage in purging behaviors (like self-induced vomiting), are highly susceptible to electrolyte abnormalities, most notably hypokalemia. Bupropion lowers the seizure threshold in a dose-dependent manner. When combined with the electrolyte derangements seen in bulimia nervosa, the risk of developing life-threatening generalized tonic-clonic seizures increases dramatically.
Step-by-Step Solution
Key Concept
Bupropion is an atypical antidepressant that is absolutely contraindicated in patients with a current or prior diagnosis of bulimia nervosa or anorexia nervosa due to an increased risk of seizures.