Bupropion-warfarin combination: a serious complication

Depressive illness and thromboembolic disorders are both highly prevalent. Warfarin is frequently combined with an antidepressant drug, the choice of which depends mainly on the risk of a hemorrhagic complication. Patients requiring the warfarin are often in the older age group, where the newer antidepressants with a better safety profile are preferred over tricyclic antidepressants. We report herein, a patient who was on bupropion for depression, when he developed deep vein thrombosis high-risk. Warfarin was started. While on this combination bupropion was abruptly stopped. This caused a more than two-fold elevation of international normalized ratio (INR) above the level, which is considered a high-risk for a hemorrhagic complication. INR reverted back to the desired level on reintroduction of bupropion. This indicates that a bupropion-warfarin combination should be used with the caution, though there has been no reported interaction so far.