Bupropion Linked With Delayed-Onset Urticaria
By Lorraine L. Janeczko
NEW YORK - Bupropion may put patients at risk for delayed-onset urticaria, a nationwide study from Taiwan has shown.
Doctors should consider this possibility in patients on bupropion -- especially patients under 40 and those with a history of urticaria -- to avoid more severe allergic responses, the authors wrote in a report online November 14 in PLoS ONE.
"Clinicians may not relate this adverse effect, which is not commonly appreciated, to the drug because of its delayed onset," said Dr. James M. Wright of the University of British Columbia in Vancouver, Canada, in an email to Reuters Health.
Dr. Wright, who edited the journal article manuscript but was not otherwise involved in the study, said, "Doctors should be more cautious about prescribing bupropion."
Bupropion-induced urticaria seldom develops alone and sometimes appears with other more serious allergic reactions, including arthralgia, angioedema, serum sickness-like reaction, and anaphylactic symptoms, the authors warn.
They say hives mustn't be confused with other skin diseases that appear similar and are also itchy.
To estimate the incidence of bupropion-induced delayed-onset urticaria, Dr. Tung-Ping Su of Taipei Veterans General Hospital and National Yang-Ming University and colleagues worked with 10 years of data from Taiwan's National Health Insurance Dataset.
From 65,988 patients with depression, they identified 2839 new bupropion users (4.3% of patients) and matched them 1:4 by age and sex with a non-bupropion group (n=11,356; 17.2% of patients).
The median age overall was 41. Most patients (n=8,540; 60.16%) were female. The most common comorbidities were liver disease (n=4,682; 33.3% of patients) and diabetes (n=2,833; 20.3% of patients).
Overall, 4,416 patients (31.32%) had a history of urticaria.
Within four weeks of starting the medication, the bupropion users had a higher risk of urticaria (cumulative incidence, 16.56% vs 9.16%; risk ratio 1.81; p=0.001). The risk was confined to patients under age 40 (risk ratio, 2.25; p<0.001), and it was high in both males and females.
In the bupropion group, urticaria occurred more frequently on Days 15 through 28 than on Days 1 through 14 (p=0.002).
Delayed-onset urticaria was more frequent in patients in the bupropion group than for patients in the non-bupropion group (cumulative incidence, 11.98% vs 5.11%; risk ratio, 2.34; p<0.001).
The only independent risk factor for bupropion-related urticaria was a history of urticaria (hazard ratio 3.03; p<0.001).
When the authors compared cumulative rates of urticaria in bupropion users and in patients receiving all other types of new antidepressant prescriptions in Taiwan, only bupropion users showed delayed onset.
"This was a good large study that established a firm connection between bupropion and urticaria. It is likely that bupropion causes urticaria," said Dr. Anton Alexandroff, a consultant dermatologist at the University Hospitals of Leicester in Leicestershire, United Kingdom, by email to Reuters Health.
"Previously no firm connection had been established. There were only published case reports, which had limited value," he said.
"Now physicians should advise their patients that bupropion can cause urticaria, and that, if this happens, they should consider changing to another medication," he said. Dr. Alexandroff was not involved in the study.
The authors did not respond to a request for comment.
SOURCE: https://bit.ly/1e92z8s
PLoS ONE 2013.
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