Bupropion is an antidepressant with excellent tolerability and few side effects or drug interactions. These characteristics suite it well for use both in the elderly and in the medically ill. However, early reports of seizures with bupropion therapy in patients with bulimia limited its use. The pharmacology, efficacy, toxicity, and side effect profile of both the immediate release (IR) and the recently available sustained release (SR) formulations of bupropion are reviewed. Bupropion SR is associated with a reduced seizure incidence (0.1%) compared to that found with the IR formulation (0.4%). Recent reports, however, demonstrate that the half-life of bupropion is prolonged in the elderly and that the elderly accumulate bupropion metabolites. Potential toxic effects, including seizures and psychosis, may result from high bupropion plasma levels and the accumulation of bupropion metabolites in the elderly or in those with impaired renal or liver function. Clinical reports in the elderly demonstrate that lower (75-225 mg/day) doses of bupropion are associated with fewer side effects and equal efficacy to that found with higher doses. Bupropion is a good antidepressant choice for the elderly and the medically ill, provided additional precautions, including the use of low doses, are taken. Bupropion should either be avoided or be used with extreme caution in anyone who is at increased risk of seizures or who has a history of psychosis or an eating disorder
