Exploring the Potential Use of Bupropion in Treating Substance Use Disorders: A Narrative and Article Review Exploring the Efficacy of Bupropion and Hydroxyzine in Pharmacotherapy for Substance Abuse and PTSD-Related Sleep Disturbances: A Literature Review


Please respond to these two discussion posts:
Post 1:
Drug Assignment
Part one: Drug narrative
Bupropion Perphenazine Imipramine
Generic Name • Bupropion hydrochloride
• Zyban
• Wellbutrin IR
• Wellbutrin SR
• Wellbutrin XL. • Piperazinyl phenothiazine
• Trilafon® • Tofranil
• Imipramine pamoate
Drug Classification • Norepinephrine and Dopamine Reuptake Inhibitors (NDRI)
• Noncompetitive inhibitor of nicotine α4β2 receptor
(Costa et al., 2019) • Antipsychotic Agent
• Tricyclic antidepressants (TCAs)
Mental Health Uses • Treatment of depressive disorder • Schizophrenia
• Mania
• Agitated behaviour
• Severe anxiety • Second-line treatment of depression
Oral Dosing Range • A dose not exceeding 450 mg per day for patients with high chances of seizures
• Double dosage of 150mg per day
(Khan et al., 2016)
• 4 to 16 mg for two to three times per day (NLM, 2020) • 75mg per day (Fayez & Gupta, 2020)
Cost for a one-month supply 60 tablets of 150mg Bupropion XL 139.61$ 60 tablets of 4mg Perphenazine 30.06$ 30 capsules of Imipramine pamoate 161.47$
High-Risk Info • Contraindicated in patients with seizures, bulimia or anorexia nervosa
• Contraindicated in patients under abrupt alcohol use termination.
• Toxic to the neurological and cardiac systems is dose is exceeded by 5g
• Interactions drugs that are inhibitors or inducers of CYP2B6.
(Costa et al., 2019) • Contraindicated with liver damage, hypersensitivity and severe central nervous depression
(Hartung et al., 2015 & NLM, 2020) • Contraindicated in hypersensitivity to the drug, linezolid or IV methylene blue
Common Side Effects • Seizures
• Sleep disorders
• Tension
• Headaches
• Dry mouth • Drowsiness
• Headache
• Blurry vision
• Dry mouth
• Muscle spasms
(Hartung et al., 2015 & NLM, 2020 • Dizziness
• Sedation
• Seizures
• Increased appetite
• Weight gain
Part Two: Article Summary
The article by Charntikov et al., 2018 seeks to develop new insights on the likelihood for use of N-acetylcysteine (NAC) and bupropion in managing substance use disorders arising from methamphetamine. The researchers conduct trails on female rats to assess how they respond to the administration of NAC and bupropion. Results from the study reveal potential use of bupropion in treating methamphetamine use disorder by antagonizing the reward system for methamphetamine and sucrose. An assessment on the relapse outcomes after administration methamphetamine is also highlighted in the study. Charntikov et al., 2018 show that bupropion hinders restoration of methamphetamine n female rats. Overall, this study reveals the potential for us of bupropion in treating methamphetamine addiction in human subjects.
Conventional use of bupropion is the management of depression and tobacco use addiction. However, there is potential off-label use of bupropion in the treatment of other mental problems, such as methamphetamine addiction and relapse. The results of this study align with earlier studies on this topic using male rats that repotted bupropion reduces the response to methamphetamine (Charntikov et al., 2018). More so, researchers show that female rats have a higher sensitivity to locomotor effects when bupropion is used to manage methamphetamine response. This has implications for dose levels in females. Therefore, the drug has therapeutic benefits in treating addiction symptoms among methamphetamine addiction patients. However, this is a lab experiment with non-human subjects. The researchers did not sufficiently show whether the reduced locomotion activities in the female rats after pretreating with bupropion is as a resultant effect of the drug on the methamphetamine’s hyperlocomotion activity (Charntikov et al., 2018). This has an impact on safety concerns. While this research presents potential applications, there are research gaps. Thus, when prompted to prescribe this medication for the management of substance use disorder, it would be done with utmost caution. Additional clinical research is needed to confirm the efficacy of bupropion in pharmacotherapy against substance abuse disorders on human samples.

Charntikov, S., Pittenger, S. T., Pudiak, C. M., & Bevins, R. A. (2018). The effect of N-acetylcysteine or bupropion on methamphetamine self-administration and methamphetamine–triggered reinstatement of female rats. Neuropharmacology, 135, 487-495.
Costa, R., Oliveira, N. G., & Dinis-Oliveira, R. J. (2019). Pharmacokinetic and pharmacodynamic of bupropion: an integrative overview of relevant clinical and forensic aspects. Drug metabolism reviews, 51(3), 293-313.
Fayez, R., & Gupta, V. (2020). Imipramine. https://europepmc.org/article/NBK/nbk557656
Hartung, B., Sampson, S., & Leucht, S. (2015). Perphenazine for schizophrenia. Cochrane database of systematic reviews, (3).
Hower, M. R., Karlapati, S. K., Bachu, A. K., & KARLAPATI, S. K. (2024). Perphenazine in Treatment-Resistant Schizophrenia. Cureus, 16(1).
Khan, S. R., Berendt, R. T., Ellison, C. D., Ciavarella, A. B., Asafu-Adjaye, E., Khan, M. A., & Faustino, P. J. (2016). Bupropion hydrochloride. Profiles of drug substances, excipients and related methodology, 41, 1-30.
National Library of Medicine (NLM). (2020). PerphenazinE. ncbi.nlm.nih.gov https://www.ncbi.nlm.nih.gov/books/NBK548366/
Pose 2:

The study Comparing the effect of prazosin and hydroxyzine on sleep quality in patients suffering from posttraumatic stress disorder explored the effectiveness of hydroxyzine and prazosin on sleep quality in PTSD patients. The research found both medications improved sleep and reduced nightmares, with prazosin showing the greatest improvement. Hydroxyzine also led to reductions in PTSD symptoms. The evidence suggests these medications could benefit sleep disorders and nightmares in PTSD patients (Ahmadpanah et al., 2014). Based on this study, hydroxyzine appears to be an off-label option for improving sleep in PTSD, although it is not FDA-approved for this specific use. The study’s conclusions support considering hydroxyzine for PTSD-related sleep disturbances, but clinical judgment should be applied when prescribing off-label. As such, based solely on this article, I would not feel comfortable prescribing these medications for off-label mental health use without more evidence to ensure patient safety and efficacy.
Stahl, M., S., Grady, M., M., Muntner, & Nancy. (n.d.). Stahl’s Essential Psychopharmacology. Retrieved from https://platform.virdocs.com/read/1733715/67/#/4[CT-bp-60]/2/2,/3:0,/3:0
Havican, & Billingsley. (2021). Hydroxyzine (Vistaril): Uses, Side Effects, Dosage & Reviews. GoodRx. https://www.goodrx.com/hydroxyzine-pamoate/what-is#basics
Williams, T., Phillips, N. J., Stein, D. J., & Ipser, J. C. (2022). Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, 2022(3). https://doi.org/10.1002/14651858.cd002795.pub3



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