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Auvelity

Pronunciation: aw-VEHL-ah-tee
Generic name: bupropion and dextromethorphan
Dosage form: extended-release tablets
Drug class: Miscellaneous antidepressants

Medically reviewed by Melisa Puckey, BPharm. Last updated on Sep 15, 2023.

What is Auvelity?

Auvelity is an antidepressant medicine used to treat Major Depressive Disorder (MDD) which is a specific type of depression. Auvelity is a rapid-acting antidepressant that started working as early as 1 week, and patients' depression symptoms continued to improve over time when compared to placebo in a 6-week clinical study for MDD (Study 1, NCT04019704).

Auvelity contains two active ingredients, bupropion and dextromethorphan. Auvelity is thought to work by increasing the amount of glutamate (a chemical messenger) available in your brain, which may positively affect your mood and ease depressive symptoms. It may also weakly affect your brain's other neurotransmitters, norepinephrine and dopamine.

Auvelity became an FDA-approved medicine on August 18, 2022, for adults with major depressive disorder (MDD).

How does Auvelity work?

Auvelity’s active ingredient, dextromethorphan, belongs to a drug class called N-methyl D-aspartate (NMDA) receptor antagonists (which means it blocks these receptors) and is also an agonist at the sigma-1 receptors (stimulates these receptors), these effects help improve depressive symptoms.

The other active ingredient, bupropion, belongs to a class of medicines called NDRIs (norepinephrine and dopamine reuptake inhibitors) and has an antidepressant effect that is thought to be due to its effect on neurotransmitters (chemical messengers) like norepinephrine and dopamine in your brain. Bupropion is also a CYP2D6 inhibitor that stops dextromethorphan from being broken down so that dextromethorphan levels are higher and last longer.

Auvelity side effects

Common Auvelity side effects

The most common Auvelity side effects include:

Serious Auvelity side effects

Also, see Warnings.

Auvelity may cause serious side effects, including:

Seizures. There is a risk of seizures during treatment with this medicine. The risk is higher in people who:

Do not take Auvelity with other medicines unless your healthcare provider tells you to.
If you have a seizure during treatment, stop taking this medicine and call your healthcare provider right away. Do not take this medicine again if you have a seizure.

Increases in blood pressure (hypertension). Some people may get high blood pressure during treatment. Your healthcare provider should check your blood pressure before you start taking and during treatment.

Manic episodes. Manic episodes may happen in people with bipolar disorder who take Auvelity. Symptoms may include:

Unusual thoughts or behaviors. One of the ingredients in Auvelity (bupropion), can cause unusual thoughts or behaviors, including delusions (believing you are someone else), hallucinations (seeing or hearing things that are not there), paranoia (feeling that people are against you), or feeling confused. If this happens to you, call your healthcare provider.

Eye problems (angle-closure glaucoma). Auvelity may cause a type of eye problem called angle-closure glaucoma in people with certain other eye conditions. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are. Call your healthcare provider if you have eye pain, changes in your vision, or swelling or redness in or around the eye.

Dizziness. this medicine may cause dizziness, increasing your fall risk.

Serotonin syndrome. A potentially life-threatening problem called serotonin syndrome can happen when you take Auvelity with certain other medicines. Call your healthcare provider or go to the nearest hospital emergency room right away if you have any of the following signs and symptoms of serotonin syndrome:

These are not all the possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Warnings

Auvelity may cause serious side effects, including:

Increased risk of suicidal thoughts and actions.
Auvelity and other antidepressant medicines may increase suicidal thoughts and actions in some children, adolescents, and young adults, especially within the first few months of treatment or when the dose is changed. This medicine is not for use in children.

How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?

Call your healthcare provider or get emergency help right away if you have any of the following symptoms, especially if they are new, worse, or worry you :

Who should not take Auvelity?

Do not take Auvelity if you:

Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI or one of these medicines, including the antibiotic linezolid or intravenous methylene blue.

Do not start this medicine if you stopped taking an MAOI in the last 14 days.

Do not start taking an MAOI for at least 14 days after you stop treatment with Auvelity.

Before taking Auvelity

Before you start treatment, tell your healthcare provider about all your medical conditions, including if you:

Pregnancy

Tell your healthcare provider if you are pregnant or plan to become pregnant. Auvelity may harm your unborn baby if you take it during pregnancy. Auvelity is not recommended during pregnancy.
If you become pregnant or think you are pregnant during treatment, tell your healthcare provider right away. Your healthcare provider will prescribe another treatment for females who plan to become pregnant.
There is a pregnancy registry for females who are exposed to this medicine during pregnancy. The purpose of the registry is to collect information about the health of females exposed to Auvelity and their baby. If you become pregnant during treatment, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visit online at https://womensmentalhealth.org/clinical-and-research programs/pregnancyregistry/antidepressants/.

Breastfeeding

Tell your healthcare provider if you are breastfeeding or plan to breastfeed. One of the active ingredients called bupropion, passes into your breast milk. Do not breastfeed during treatment with this medicine and for 5 days after the final dose.

How should I take Auvelity?

What happens if I miss a dose?

If you miss a dose, do not take an extra dose to make up for the dose you missed. Wait and take your next dose at the regular time. Do not take more than 1 dose of this medicine at a time.

What happens if I overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

Dosing information

Usual Adult Dose for Auvelity

Dose: One tablet once daily in the morning for three days, then increase to the maximum recommended dosage of one tablet twice daily, separated by at least 8 hours.

Comment: Prior to initiating treatment with this medicine assess blood pressure; screen patients for history of bipolar disorder, mania, or hypomania; and determine if patients are receiving any other medications that contain bupropion or dextromethorphan.

Dosage form and strength: Extended-release tablet containing dextromethorphan hydrobromide 45 mg and bupropion hydrochloride 105 mg.

What other drugs will affect Auvelity?

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Auvelity and some other medicines may affect each other causing possible serious side effects. Auvelity may affect the way other medicines work and other medicines may affect the way Auvelity works.

Especially tell your healthcare provider if you take:

Ask your healthcare provider if you are not sure if you are taking any of these medicines. Your healthcare provider can tell you if it is safe to take Auvelity with your other medicines.

Do not start or stop any other medicines during treatment without talking to your healthcare provider first. Stopping treatment suddenly may cause you to have serious side effects.

Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine.

What should I avoid while taking this medicine?

Storage

Ingredients

Active ingredients: dextromethorphan hydrobromide, bupropion hydrochloride.
Inactive ingredients: l-cysteine hydrochloride monohydrate, carbomer homopolymer, microcrystalline cellulose, colloidal silicon dioxide, crospovidone, stearic acid, and magnesium stearate.

Company

​​Distributed and Marketed by: Axsome Therapeutics, Inc. New York, NY 10007

Popular FAQ

Auvelity may start to lessen your symptoms of depression after one week of treatment. The percentage of patients who achieved symptoms that were “very much improved / much improved” at one week were 22% for Auvelity vs. 13% for placebo, a significant effect. In studies, over 50% of patients achieved a clinical response by the 6th week of treatment. Continue reading

Auvelity worked significantly better than Wellbutrin (bupropion) at relieving symptoms of depression in a small randomized double-blind, parallel trial that lasted for 6 weeks. It also had a faster onset of effect, with improvement in the Montgomery-Åsberg Depression Rating Scale (MADRS) score being observed as early as week 1 and differences being statistically significant by week 2. Continue reading

Both Auvelity and Wellbutrin are effective for depression but a small RCT (n=80) reported that Auvelity worked significantly better than Wellbutrin and took less time to start working. 43 people prescribed Auvelity experienced an overall decrease in their Montgomery-Åsberg Depression Rating Scale (MADRS) score of 13.7 points after 6 weeks compared to a decrease of 8.8 points in the 37 people prescribed bupropion (least-squares mean difference=-4.9; 95% CI=-3.1, -6.8). Continue reading

Auvelity works in several different ways because it contains two different ingredients, dextromethorphan and bupropion, although the exact way it works for depression is unknown. The dextromethorphan component targets the NMDA receptor (N-methyl-D-aspartate), the serotonin transporter (SERT), the norepinephrine transporter (NET), and the sigma-1 receptor, to regulate levels of glutamate and other neurotransmitters such as serotonin and norepinephrine. Continue reading

Auvelity is a combination oral tablet for depression containing dextromethorphan and bupropion that works differently from other antidepressants because it has a direct effect on the N-methyl-D-aspartate (NMDA) receptor as well as possibly other traditional neurotransmitter effects. It also works much faster than traditional antidepressants, and it does appear to be more effective. Continue reading

Weight gain has not been reported with Auvelity, but in one 6-week study, participants lost, on average, half a pound, while those taking placebo gained about one pound. Animal studies have also reported that the administration of dextromethorphan/bupropion did not affect body weight, weight gain, or food consumption. Continue reading

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.