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BAL HARBOUR, FLA. — Extended-release bupropion appears to be a safe and effective treatment for adults with attention-deficit hyperactivity disorder, with more than 50% of patients experiencing at least a 30% reduction in core symptoms while on the drug, Dr. Joseph Horrigan reported in a poster at the annual meeting of the American Neuropsychiatric Association.
About 40%-70% of children with attention-deficit hyperactivity disorder (ADHD) continue to experience symptoms into adulthood. Interest has been rising in nonstimulant treatments for adults; currently, atomoxetine HCI is the only nonstimulant medication approved for adult ADHD. Bupropion, a nonstimulant norepinephrine and dopamine reuptake inhibitor, has been shown useful in the treatment of pediatric ADHD, and in ADHD with comorbid depression and bipolar disorder.

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Dr. Horrigan, of GlaxoSmithKline, reported the results of the company’s multicenter randomized placebo-controlled trial of extended-release bupropion in 162 ADHD patients aged 18-60 years. The active group contained 81 patients and the placebo group contained 81 patients.
All patients began with a 150-mg dose given once daily in the morning. In weeks 2-4, patients received 300 mg each morning. In weeks 5-8, the dosage could be increased to 450 mg/day if there was less than a 30% improvement on the ADHD Rating Scale, or if the Clinical Global Impression-Improvement Scale score was greater than two, and if the patient was tolerating 300 mg/day. Dosages could be reduced to a 300 mg/day minimum if adverse events occurred.
By the end of the study, 70.4% of the patients in the active group were taking 450 mg/day, 28.4% were taking 300 mg/day, and 1.2% (only one patient) was taking 150 mg/day. The mean final dose of bupropion XL was 393 mg/day.
By week 5, 55% of patients taking the study drug had experienced at least a 30% reduction on both the inattentive and hyperactivity-impulsivity domains of the ADHD Rating Scale. The study indicated that patients experienced relief from symptoms compared with placebo. Previous studies have shown that serum levels of bupropion XL increase soon after an 8 a.m. dosing, rising to a peak level of 120 ng/mL from noon to 2 p.m., and slowly falling to around 60 ng/mL by 8 p.m. and 20 ng/mL by 8 a.m. the next day.
The most commonly reported adverse events were headache (17% bupropion vs. 14% placebo) and dry mouth (12% bupropion vs. 5% placebo), compared with 5% placebo. Other adverse events reported were nausea, nasopharyngitis, dizziness, constipation, somnolence, fatigue, irritability, and tinnitus. Most adverse events occurred in the first 2 weeks. Bupropion and placebo had equal effects on blood pressure and heart rate.
BY MICHELE G. SULLIVAN
Mid-Atlantic Bureau
COPYRIGHT 2004 International Medical News Group
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