Bupropion for the treatment of neuropathic pain

Bupropion for the treatment of neuropathic pain. A short review.

In a (2010) review special emphasis was given to Bupropion as a specific inhibitor of neuronal nor adrenaline re uptake and at the same time a weak inhibitor of dopamine re uptake. Which according to the authors might be of some promise in the treatment of neuropathic pain.[1]

Although there are not many studies available we can find comparable statements, as Bupropion is an anti-depressant and:

“several anti-depressants have been efficacious in the management of chronic neuropathic pain, including the tricyclic anti-depressants (particularly the tertiary-amine sub types, such as Amitriptyline, Doxepin, and imipramine) as well as Venlafaxine and duloxetine.” [2]

However, in the mixed low back pain syndrome, were neuropathic mechanisms play a role, Bupropion a recent trial found no evidence of efficacy in patients with chronic low back pain.[3]

Pain relief was improved

Some older studies supported the efficacy of this medicine. In one cross over trial forty-one patients with neuropathy were treated during 6 weeks with either 150 mg Bupropion SR or placebo.

If treated with Bupropion SR, neuropathic pain relief was improved or much improved in 30 (73%) patients. One of these patients became pain-free. Side effects were primarily dry mouth, insomnia, headache, gastrointestinal upset, tremor, constipation, and dizziness.

The conclusion of the authors was: “This placebo-controlled crossover trial showed that Bupropion SR (150-300 mg daily) was effective and well tolerated for the treatment of neuropathic pain.”[4]

Although the data are somewhat thin, and sub optimal studies, even open studies exist [5]. One might consider Bupropion in the treatment of neuropathic pain if other drugs fail to help.

February 2010, Jan M. Keppel Hesselink, MD, PhD