Published: 29 September 2020
Updated: 7 April 2021
Safety Information
Monitoring
Possible risk of psoriasis exacerbation with bupropion
Update to original communication
7 April 2020
During the monitoring period (29 September 2020 to 29 March 2021), the Centre for Adverse Reactions Monitoring (CARM) did not receive any further reports of psoriasis exacerbation with bupropion.
Medsafe will continue to monitor this issue through routine pharmacovigilance. The benefit-risk balance for bupropion remains positive and no further action is required at this time.
Original Communication
29 September 2020
Monitoring finishes on 29 March 2021
Medsafe is highlighting a possible risk of psoriasis exacerbation with the use of bupropion. The aim of this communication is to encourage further reports to obtain more information on this potential safety concern.
This potential safety concern was triggered by a report received by the Centre for Adverse Reactions Monitoring (CARM). The report (CARM ID 135639) describes a 56-year-old male patient who was prescribed bupropion for smoking cessation. He reported to have an exacerbation of his psoriasis 15 days after starting bupropion.
Products affected
Additional information
Regulator actions
Reporting
Products affected
| Product name | Sponsor |
|---|---|
| Bupropion | |
| Zyban modified release tablet, 150mg | GlaxoSmithKline (NZ) Ltd |
Bupropion works by inhibiting the reuptake of the chemicals noradrenaline
and dopamine in the nervous system. It has minimal effects on serotonin.
It is indicated as an aid in smoking cessation [1].
Additional information
Psoriasis is a chronic inflammatory skin condition. A mechanism whereby bupropion may exacerbate psoriasis is unknown. However, drug-induced psoriasis occurs more frequently in patients with a history of smoking, obesity, diabetes, hypertension, and dyslipidaemia. The most common medicines to induce or aggravate psoriasis include beta-blockers, lithium, antimalarials, antibiotics, non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors and tumour necrosis factor-alpha inhibitors [2].
There are some published case reports of people with pre-existing and well-controlled psoriasis who have had an exacerbation of their psoriasis within two weeks of starting bupropion. In most cases, the exacerbation resolved when bupropion was stopped [3-7].
Although most of the published case reports were of patients with pre-existing psoriasis, we also encourage reports of patients who experienced a new-onset of psoriasis when starting on bupropion.
More information, including advice on how to take this medicine and known side effects, can be found in the consumer medicine information (CMI) and data sheet.
Search for consumer medicine information and data sheets
Regulator actions
Medsafe is placing this safety concern on the Medicines Monitoring
()
scheme to encourage reporting of cases where psoriasis has been exacerbated
with the use of bupropion. Please also report cases where patients experience
new-onset psoriasis when starting on bupropion.
Reporting
Consumers and healthcare professionals are encouraged to report suspected adverse reactions to medicines to the Centre for Adverse Reactions Monitoring (CARM).
References
- GlaxoSmithKline NZ Limited. 2020. ZYBAN New Zealand Data Sheet 14 January 2020. URL: https://www.medsafe.govt.nz/profs/Datasheet/z/Zybantab.pdf (accessed 20 August 2020).
- Wu B. 2017. DermNet NZ: Drug-induced psoriasis June 2017. URL: https://dermnetnz.org/topics/drug-induced-psoriasis/ (accessed 9 September 2020).
- Cox NH, Gordon PM and Dodd H. 2002. Generalized pustular and erythrodermic psoriasis associated with bupropion treatment. British Journal of Dermatology 146(6): 1061-3. DOI: 10.1046/j.1365-2133.2002.04679.x (accessed 9 September 2020).
- Matos-Pires E, Campos S, Mendes-Bastos P, et al. 2017. Erythrodermic psoriasis induced by bupropion. Journal of the European Academy of Dermatology and Venereology 31(2): e129-e30. DOI: 10.1111/jdv.13876 (accessed 9 September 2020).
- Singh P, Cassel K, Moscati R, et al. 2017. Acute generalized erythrodermic pustular psoriasis associated with Bupropion/Naltrexone (Contrave®). The Journal of Emergency Medicine 52(4): e111-e13. DOI: https://doi.org/10.1016/j.jemermed.2016.11.034 (acessed 20 August 2020).
- Surovik J, Riddell C and Chon S. 2010. A case of bupropion-induced Stevens-Johnson syndrome with acute psoriatic exacerbation. Journal of Drugs in Dermatology 9(8): 1010-12. URL: https://pubmed.ncbi.nlm.nih.gov/20684153/ (accessed 20 August 2020).
- Akpınar A, Ceyhan MA and Yaman AR. 2013. Psoriasis triggered by bupropion in a patient with major depression. Journal of Mood Disorders 3(4): 186-8. DOI: 10.5455/jmood.20130905044624 (accessed 28 August 2020).
