Auvelity - Revision history

CategoryClaude: Sentence-case category link per house style (NMDA_Receptor_Antagonists → NMDA_receptor_antagonists)

2026-05-23T05:02:23Z

Sentence-case category link per house style (NMDA_Receptor_Antagonists → NMDA_receptor_antagonists)

← Older revision		Revision as of 05:02, 23 May 2026
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	[[Category:NMDA ~~Receptor Antagonists~~]]		[[Category:NMDA receptor antagonists]]
	[[Category:Antidepressants]]		[[Category:Antidepressants]]
	[[Category:Combo Products]]		[[Category:Combo Products]]
	[[Category:Dissociatives]]		[[Category:Dissociatives]]

MDElliottMD: Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

2026-05-19T03:16:04Z

Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

← Older revision		Revision as of 03:16, 19 May 2026
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	\| pregnancy = Limited data; avoid		\| pregnancy = Limited data; avoid
	\| legal = Rx		\| legal = Rx
	\| intro = '''Auvelity''' is a fixed-dose combination of dextromethorphan 45 mg and bupropion 105 mg, FDA-approved August 2022 for major depressive disorder. The combination addresses dextromethorphan's rapid first-pass CYP2D6 metabolism by exploiting bupropion's CYP2D6 inhibition — without bupropion, oral dextromethorphan never reaches plasma levels sufficient for NMDA antagonism. The rationale builds on ketamine's antidepressant effect: low-dose NMDA antagonism may produce rapid antidepressant response through downstream AMPA/BDNF/synaptogenesis pathways rather than monoamine modulation. Significant antidepressant separation from placebo by week 1 in trials.		\| intro = '''Auvelity''' is a fixed-dose combination of dextromethorphan 45 mg and bupropion 105 mg, FDA-approved August 2022 for major depressive disorder. The combination addresses dextromethorphan's rapid first-pass CYP2D6 metabolism by exploiting bupropion's CYP2D6 inhibition, without bupropion, oral dextromethorphan never reaches plasma levels sufficient for NMDA antagonism. The rationale builds on ketamine's antidepressant effect: low-dose NMDA antagonism may produce rapid antidepressant response through downstream AMPA/BDNF/synaptogenesis pathways rather than monoamine modulation. Significant antidepressant separation from placebo by week 1 in trials.
	\| pharmacodynamics= '''Dextromethorphan:''' Uncompetitive NMDA receptor antagonist (binds open channel like ketamine/memantine), sigma-1 receptor agonist, modest SERT and NET inhibition. '''Bupropion:''' Norepinephrine-dopamine reuptake inhibitor (NDRI) plus potent CYP2D6 inhibition (blocking dextromethorphan's metabolism to dextrorphan).		\| pharmacodynamics= '''Dextromethorphan:''' Uncompetitive NMDA receptor antagonist (binds open channel like ketamine/memantine), sigma-1 receptor agonist, modest SERT and NET inhibition. '''Bupropion:''' Norepinephrine-dopamine reuptake inhibitor (NDRI) plus potent CYP2D6 inhibition (blocking dextromethorphan's metabolism to dextrorphan).
	\| effects = Dizziness, headache, diarrhea, somnolence, dry mouth, sexual dysfunction. Lower seizure risk than higher-dose bupropion alone. Avoid in patients with seizure disorders or eating disorders (bupropion contraindication). Avoid with MAOIs (serotonin syndrome / hypertensive crisis risk).		\| effects = Dizziness, headache, diarrhea, somnolence, dry mouth, sexual dysfunction. Lower seizure risk than higher-dose bupropion alone. Avoid in patients with seizure disorders or eating disorders (bupropion contraindication). Avoid with MAOIs (serotonin syndrome / hypertensive crisis risk).

Maintenance script: Create Auvelity page (Stahl-sourced detail with skepticism)

2026-05-16T01:56:00Z

Create Auvelity page (Stahl-sourced detail with skepticism)

New page

{{MedTemplate
| brand = Auvelity (dextromethorphan/bupropion ER)
| classes = NMDA receptor antagonist + sigma-1 agonist + NDRI (combination)
| mechanism = Fixed-dose combination of dextromethorphan 45 mg (NMDA antagonist + sigma-1 agonist + SERT/NET inhibition) with bupropion 105 mg (NDRI). Bupropion's role is dual: provides NDRI antidepressant action AND inhibits CYP2D6 to slow dextromethorphan metabolism, achieving therapeutic plasma levels that are otherwise unattainable due to rapid first-pass metabolism.
| uses = Major depressive disorder in adults (FDA-approved August 2022)
| starting_dose = 1 tablet (dextromethorphan 45 mg / bupropion 105 mg) PO daily × 3 days, then increase to 1 tablet BID
| preparations = Dextromethorphan 45 mg + bupropion 105 mg ER tablets
| fda_max = 2 tablets/day (dextromethorphan 90 mg / bupropion 210 mg)
| routes = Oral
| onset = Significant antidepressant response by week 1 in trials (faster than monoaminergic antidepressants which take 4-6 weeks)
| duration = Sustained with twice-daily dosing
| halflife = Dextromethorphan ~22 h (when CYP2D6 inhibited); bupropion ~21 h
| bioavailability = Not formally characterized for the combination
| pregnancy = Limited data; avoid
| legal = Rx
| intro = '''Auvelity''' is a fixed-dose combination of dextromethorphan 45 mg and bupropion 105 mg, FDA-approved August 2022 for major depressive disorder. The combination addresses dextromethorphan's rapid first-pass CYP2D6 metabolism by exploiting bupropion's CYP2D6 inhibition — without bupropion, oral dextromethorphan never reaches plasma levels sufficient for NMDA antagonism. The rationale builds on ketamine's antidepressant effect: low-dose NMDA antagonism may produce rapid antidepressant response through downstream AMPA/BDNF/synaptogenesis pathways rather than monoamine modulation. Significant antidepressant separation from placebo by week 1 in trials.
| pharmacodynamics= '''Dextromethorphan:''' Uncompetitive NMDA receptor antagonist (binds open channel like ketamine/memantine), sigma-1 receptor agonist, modest SERT and NET inhibition. '''Bupropion:''' Norepinephrine-dopamine reuptake inhibitor (NDRI) plus potent CYP2D6 inhibition (blocking dextromethorphan's metabolism to dextrorphan).
| effects = Dizziness, headache, diarrhea, somnolence, dry mouth, sexual dysfunction. Lower seizure risk than higher-dose bupropion alone. Avoid in patients with seizure disorders or eating disorders (bupropion contraindication). Avoid with MAOIs (serotonin syndrome / hypertensive crisis risk).
| interactions = <pharmaInteractions/>
}}

[[Category:NMDA Receptor Antagonists]]
[[Category:Antidepressants]]
[[Category:Combo Products]]
[[Category:Dissociatives]]