Bupropion-Methylphenidate Combination and Grand Mal Seizures

Ickowicz, Abel

doi:10.1177/070674370204700824

Cited by 9 publications

(4 citation statements)

References 6 publications

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“…Decreased appetite, weight loss and greater increases in blood pressure and pulse (generally clinically nonsignificant) seemed to be more frequent in patients on polypharmacy. However, risk of seizures and myoclonus was reported in some individual case reports and should be considered when managing the combination (Feeney and Klykylo, 1997 ;Ghaziuddin et al 2001 ;Ickowicz, 2002 ;Schertz and Steinberg, 2008). This is consistent with previous data regarding these drug classes (Graham and Coghill, 2008 ;Jerrell and McIntyre 2009 ;Settle 1998 ;Wilens et al 2004) and might be related to the pharmacokinetic and pharmacodynamic properties of the compounds, which may increase the efficacy but also the risks of the combination (Belle et al 2002 ;Baird, 2003 ;Martin, 2003).…”

Section: Potential Risks Associated With Polypharmacy With Antidepressupporting

confidence: 86%

“…Combining SSRIs with stimulants was generally well tolerated, but some case reports related it to an increased risk of seizures and myoclonus in paediatric patients (Feeney and Klykylo, 1997 ;Ghaziuddin et al 2001 ;Schertz and Steinberg, 2008). A risk of seizures was also reported for the combination of bupropion and stimulants (Ickowicz, 2002). As for SSRIs combined with antipsychotics, sedation and weight gain were reportedly the most common AEs in open studies and case series, whereas case reports related the combination to the occurrence of enuresis (Took and Buck, 1996), extrapyramidal symptomatology and tardive dyskinesia (Budman et al 1995 ;Daniel et al 1996).…”

Section: Safetymentioning

confidence: 99%

“…Most combinations were relatively well tolerated in open-label studies and RCTs, but there were several case reports of severe AEs in paediatric patients treated with combinations involving antidepressants (Budman et al 1995 ;Burke et al 1995 ;Cruz-Flores et al 1995 ;Daniel et al 1996 ;Took and Buck, 1996 ;Feeney and Klykylo, 1997 ;Sallee et al 2000 ;Ghaziuddin et al 2001 ;Ickowicz, 2002 ;George et al 2005 ;Coskun and Zoroglu, 2008 ;Schertz and Steinberg, 2008 ;Park and Jung, 2010 ;Mahapatra et al 2011). These severe AEs were mainly related to unexpected or underestimated pharmacokinetic interactions, potentiation of hyperserotonergic states or poorly understood pharmacodynamic mechanisms due to neurodevelopmental status or genetic vulnerability.…”

Section: Potential Risks Associated With Polypharmacy With Antidepresmentioning

confidence: 99%

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Polypharmacy with antidepressants in children and adolescents

Díaz‐Caneja

Espliego

Parellada

et al. 2012

Int. J. Neuropsychopharm.

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The aim of this study was to review current epidemiological data on the use of antidepressants in co-prescription with other psychotropic drugs in children and adolescents, as well as available efficacy and safety information. A Medline search from inception until February 2012 was performed to identify epidemiological and clinical studies, reviews and reports containing potentially relevant information on polypharmacy with antidepressants in young people. There has been an increase in polypharmacy in children and adolescents involving antidepressants in recent years. Antidepressants have become one of the drug classes most frequently prescribed in combination and are commonly co-prescribed with stimulants and antipsychotics. Most information regarding efficacy and safety of polypharmacy patterns was provided by case series and open-label studies. Efficacy studies gave some support for the use of a combination of antidepressants and antipsychotics in the management of refractory obsessive-compulsive disorder and some residual symptoms in major depressive disorder. Even less empirical support was found for a combination of stimulants and antidepressants in co-morbid attention deficit hyperactivity disorder and mood or anxiety disorders. Adverse events were similar to those found with individual medication groups, with severe adverse events mostly reported by individual case reports. The use of polypharmacy with antidepressants has become a regular practice in clinical settings. Although there is still little efficacy and safety information, preliminary evidence points to the potential clinical usefulness of some polypharmacy patterns. Further research on patients with co-morbidities or more severe conditions is needed, in order to improve knowledge of this issue.

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Section: Potential Risks Associated With Polypharmacy With Antidepressupporting

confidence: 86%

Section: Safetymentioning

confidence: 99%

Section: Potential Risks Associated With Polypharmacy With Antidepresmentioning

confidence: 99%

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Polypharmacy with antidepressants in children and adolescents

Díaz‐Caneja

Espliego

Parellada

et al. 2012

Int. J. Neuropsychopharm.

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“…14 Buproprion lowers the seizure threshold and, if used in combination with methylphenidate, tonic-clonic seizures can be induced. 15…”

Section: Risk Of Seizures With Stimulant Medicationmentioning

confidence: 99%

Utility of the Electroencephalogram in Attention Deficit Hyperactivity Disorder

Millichap

Stack

2011

Clin EEG Neurosci

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An electroencephalogram (EEG) has not been routinely utilized in the evaluation of children with attention deficit hyperactivity disorder (ADHD). The utility of the EEG in ADHD is unclear. A recent study in our laboratory using sleep and sleep deprivation routinely found one in four non-epileptic children evaluated for attention deficit disorder has epileptiform discharges in the EEG, more than half focal. The majority of abnormalities (97.5%) occur in sleep and sleep-deprived records compared to 7% in prior wake only records. A review of eight publications showed that laboratories using awake only as routine EEG recordings report a relatively low prevalence of epileptiform discharges, whereas the higher prevalence of epileptiform discharges is seen in those with more prolonged sleep recordings. We have determined that sleep deprivation and sleep are essential to rule out an abnormal EEG in attention deficit disorder. In patients with attention deficit disorder complicated by epilepsy, stimulant therapy is generally safe, provided seizures are controlled by antiepileptic medication. Patients with epilepsy or subclinical electrographic abnormalities not treated with anticonvulsants are at increased risk of seizures when stimulant therapy is introduced, especially extended-release methylphenidate. Apart from an increase in risk of seizures and need for caution in use of stimulants, studies show that epileptiform discharges in the electroencephalogram are linked to a better response of attention deficit to methylphenidate and a higher cognitive performance. Transient cognitive impairment related to subclinical electrographic abnormalities responds to antiepileptic medication. An EEG is important in selected cases of attention deficit disorder and is useful in choice of medication, especially in children with lack of awareness and transient cognitive impairment.

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Neuropharmacology of Attention‐Deficit/Hyperactivity Disorder

Glaser

Castellanos

Margulies

2007

Handbook of Contemporary Neuropharmacology

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This chapter provides an overview of various treatment options for Attention‐Deficit/Hyperactivity Disorder (ADHD). While methylphenidate in various forms remains the mainstay of pharmacological treatment, amphetamine and non‐stimulant options are also viable and increasingly supported by controlled trials. The authors provide a comprehensive review of the literature which informs the concluding reflections on clinical practice in this rapidly evolving field.

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Bupropion-Methylphenidate Combination and Grand Mal Seizures

Cited by 9 publications

References 6 publications

Polypharmacy with antidepressants in children and adolescents

Polypharmacy with antidepressants in children and adolescents

Utility of the Electroencephalogram in Attention Deficit Hyperactivity Disorder

Neuropharmacology of Attention‐Deficit/Hyperactivity Disorder

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