Conversion from Sustained‐Release to Immediate‐Release Bupropion: Patient Tolerability and Economic Impact

Study Objective. To assess patient tolerability and impact on institutional drug acquisition costs of converting patients from sustained‐release bupropion to generic immediate‐release bupropion. Design. Retrospective medical record review. Setting. Veterans Affairs medical center. Patients. One hundred three outpatients who had been receiving sustained‐release bupropion and were converted to immediate‐release bupropion at equal individual doses and frequencies. Measurements and Main Results. Medical records were reviewed for documentation of adverse effects thought to be associated with bupropion treatment; reports of seizure occurrence were specifically sought. Patterns of bupropion dosing were also assessed. Institutional drug acquisition costs were evaluated by comparing actual costs of bupropion for each patient before and after conversion. Adverse effects reported with immediate‐release bupropion were those commonly associated with this drug (headache, agitation, chest pain, and gastrointestinal complaints) and were neither unusually frequent nor severe. No seizures were reported after the drug conversion. Mean daily doses of bupropion were not significantly different after conversion. Mean single doses of immediate‐release bupropion were below 150 mg; however, six patients did receive single doses of 200 mg. After conversion, the annual institutional drug acquisition cost for bupropion decreased by approximately $48,910. Conclusion. Conversion from sustained‐release bupropion to immediate‐release bupropion appears to be safe. Single 200‐mg doses of immediate‐release bupropion can apparently be administered to some patients without inducing excessive adverse effects, including seizures. Marked reduction in drug acquisition costs can be achieved with this conversion.