Published: 29 September 2020

Safety Information

Monitoring

Medsafe emphasises that patients should NOT stop using any medicine or medical device subject to a monitoring communication. If you have any concerns with a medicine or medical device you are using, please contact your healthcare professional. A monitoring communication does not mean that the medicine or medical device causes an adverse event.

M2 Logo Possible risk of psoriasis exacerbation with bupropion

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 (M2 Logo) 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

  1. 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).
  2. Wu B. 2017. DermNet NZ: Drug-induced psoriasis June 2017. URL: https://dermnetnz.org/topics/drug-induced-psoriasis/ (accessed 9 September 2020).
  3. 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).
  4. 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).
  5. 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).
  6. 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).
  7. 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).
Hide menus
Show menus
0 1 2 4 5 6 7 9 [ /