Auvelity dosage, forms, and strengths

Auvelity is a brand-name prescription antidepressant that can relieve the symptoms of major depressive disorder in less time than other antidepressants. Auvelity tablets contain two antidepressant drugs. The most important one is dextromethorphan, a common cough medicine found in most over-the-counter (OTC) cough, cold, or flu remedies. The second one is bupropion, a common antidepressant that people recognize as Wellbutrin. It’s added to the drug to increase the blood levels of dextromethorphan. Auvelity doses are taken twice daily as tablets. 

Auvelity forms and strengths

Auvelity can only be purchased in one dosage format:

• Extended-release tablets: 45 mg dextromethorphan/105 mg bupropion

Auvelity dosage for adults

The Food and Drug Administration (FDA) has approved Auvelity as a treatment for major depressive disorder (MDD) in adults. The extended-release tablets are taken by mouth twice per day, with at least eight hours in between each dose. Auvelity contraindications include seizure disorders, eating disorders (bulimia or anorexia), allergies to bupropion or dextromethorphan, or abrupt discontinuation of alcohol or drugs like benzodiazepines, barbiturates, or anti-seizure drugs.

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Auvelity dosage for major depressive disorder

It’s easy to confuse depression or feeling blue for major depressive disorder (MDD) or a major depressive episode (MDE), but they’re different. MDD and MDEs are ongoing, nonstop, daily mood problems that cause significant distress or impairment. Healthcare professionals diagnose MDD when people show depression symptoms for most of the day every day for two weeks. The standard first-line therapies for MDD are cognitive behavioral therapy (CBT) and antidepressants, such as Wellbutrin (bupropion), selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), and other types of antidepressants. 

Both CBT and antidepressants take several weeks to start showing results. Auvelity is a unique drug that can improve MDD symptoms in as little as a week. It contains two drugs that work as antidepressants: dextromethorphan and bupropion (better known as Wellbutrin). However, dextromethorphan is the main depression-fighting drug in Auvelity. Bupropion is added to the drug to slow down the body’s metabolism of dextromethorphan. In this way, dextromethorphan levels in the blood stay elevated for a longer time. The daily dose of bupropion in Auvelity (210 mg) is high enough to fight off depression symptoms as well. 

How dextromethorphan in Auvelity works is not well known. Like other antidepressants, it changes the balance of chemicals in the brain that pass signals between nerves.

Patients can expect to take two doses daily, one in the morning and one in the evening. These doses must be separated by at least eight hours. Missed doses should be skipped. 

• Standard Auvelity dosage for major depressive disorder: One 45/105 mg tablet taken by mouth twice daily at least eight hours apart

Auvelity dosage for children

Auvelity is not FDA approved for use in children.

Auvelity dosage restrictions

Dosages of Auvelity will be reduced to once-daily doses for people with kidney problems. Some people who are poor metabolizers of dextromethorphan will also take only one tablet daily. 

No dosage adjustment is required for people with mild-to-moderate liver impairment. Doctors will avoid prescribing Auvelity to people with severe liver or kidney disease and those who are on dialysis.

• Patients with moderate renal impairment (creatinine clearance between 30 mL/min and 59 mL/min): One 45/105 mg tablet taken once daily

• Patients with severe renal impairment (creatinine clearance <10 mL/min): Avoid use

• Patients with severe hepatic impairment (Child-Pugh class C): Avoid use

• CYP2D6 poor metabolizers: One 45/105 mg tablet taken once daily

How to take Auvelity

Auvelity is taken by mouth twice a day, though some people may need to take only one dose daily. When first starting Auvelity, make sure to take only one dose daily for the first three days.

• Take the dosage as prescribed. Never take more than two doses in a day.

• Please read the Medication Guide before you start this drug.

• Auvelity can be taken with food or on an empty stomach.

• Swallow the oral tablet whole. Do not crush, break, cut, or chew it. 

• Take Auvelity doses at least eight hours apart.

• This medicine may take a few weeks to begin showing significant results. Give it time to work. 

• Store Auvelity tablets at room temperature (68°F to 77°F) in a closed container out of the reach of children and pets.

Auvelity dosage FAQs

What dosage form is Auvelity available as?

Auvelity is currently only available as an extended-release tablet. 

How long does it take Auvelity to work?

Auvelity is the first rapid-acting antidepressant approved by the FDA. In a clinical study, patients showed significant changes in their mood and symptoms by the end of the first week of treatment. Maximum relief of symptoms occurred after four weeks of twice-daily Auvelity doses. 

How long does Auvelity stay in your system?

Auvelity is designed to keep dextromethorphan in the body for as long as safely possible. When taken in cough syrups or cold medicines, the half-life of dextromethorphan is about two to four hours. When taken as Auvelity tablets, the half-life of dextromethorphan rises to about 22 hours. Bupropion in Auvelity has a half-life of 15 hours. That means it will take almost five days to clear the last dose of Auvelity from the body.

What happens if I miss a dose of Auvelity?

If a dose is missed, skip the missed dose. Wait until it’s time to take the next dose and take that dose as scheduled. Do not take extra tablets to make up for a missed dose.

How long can you take Auvelity?

Auvelity is intended for long-term treatment if necessary. A 12-month clinical study of Auvelity did not discover side effects due to long-term use. 

How do I stop taking Auvelity?

Both bupropion and dextromethorphan can cause withdrawal symptoms when they are abruptly discontinued, so it is important to speak to a healthcare provider before stopping Auvelity. They can implement a titration plan to stop taking it.

There are many reasons to stop taking an antidepressant. The best reason is that it has cured depression. However, sometimes the medication doesn’t work. Sometimes people can’t take the side effects. Finally, people might experience severe side effects, such as seizures, racing heartbeats, or severe allergic reactions.

Healthcare professionals have many options when treating depression. These include tricyclic antidepressants, SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and others.

What is the maximum dosage for Auvelity?

Do not take more than two Auvelity tablets daily.

Can you overdose on Auvelity?

If too much Auvelity is taken, call a poison control helpline or get immediate medical attention. 

You can overdose on Auvelity. The drug is designed to maximize the concentrations and half-life of dextromethorphan in the blood. Taking too much Auvelity risks a dextromethorphan overdose that can last longer than it should. The most serious possible complication of a dextromethorphan overdose is serotonin syndrome. 

Symptoms of a dextromethorphan overdose include nausea, vomiting, racing heart rate, slow breathing, seizures, hallucinations, stupor, and coma.

What interacts with Auvelity?

Auvelity has many significant drug interactions. It’s especially important that the prescriber knows about all prescription drugs, over-the-counter medications, and supplements being taken. In some cases, the Auvelity dose may need to be reduced.

Do not take Auvelity with MAOIs. You can find a list of MAOIs here. Anyone taking an MAOI must discontinue it for at least 14 days before they can safely start Auvelity.

Some drugs slow down the body’s metabolism of dextromethorphan. Bupropion is one of them—that’s why it’s there. But, other drugs can decrease its rate of metabolism, too, so there’s a greater risk of side effects.

Make sure to tell the prescribing healthcare provider about taking any drug used to alter mood, relieve mental health disorder symptoms, or induce sleepiness. These drugs include antidepressants, anticonvulsants, antipsychotics, opioids, and so on. Also, tell the healthcare provider if you’re on digoxin, a drug used to treat heart failure or irregular heartbeats.

Finally, drugs that affect dopamine levels can produce or worsen high blood pressure. The most common ones are Parkinson’s treatments.

What happens when you mix Auvelity and alcohol?

Minimize or avoid drinking alcohol when taking Auvelity. Alcohol may have stronger effects or even cause psychiatric problems when combined with bupropion.

Is it safe to take Auvelity during pregnancy?

Pregnant women should not take Auvelity. Animal studies have shown that it can harm a fetus. Women who get pregnant while on Auvelity should immediately contact the prescriber. Women who are considering pregnancy should talk to the prescriber before taking Auvelity.

Is it safe to take Auvelity while breastfeeding?

Auvelity is not recommended to take while nursing an infant, so women who are breastfeeding should ask for medical advice from the prescriber. The manufacturer recommends that women avoid breastfeeding while taking Auvelity and for at least five days after the last dose is taken. Bupropion is present in human breast milk, but the real issue is the dextromethorphan. No one knows if it’s present in human breast milk or if it affects a nursing infant. However, dextromethorphan can poison nerves, so it’s not recommended in women who are breastfeeding. 

What are Auvelity’s side effects?

The most common side effects of Auvelity are dizziness, headache, diarrhea, sleepiness, dry mouth, and sexual dysfunction.

What are the serious side effects of Auvelity?

The most serious problem associated with Auvelity and other antidepressants is the increased risk of suicidal thoughts and behaviors in young adults and teens. Nearly all antidepressants, including Auvelity, contain an FDA-mandated boxed warning about the risk of suicidal thoughts and behaviors. Other potential problems include an increased risk of seizures, high blood pressure, angle-closure glaucoma, psychosis, serotonin syndrome, severe allergic reactions, and activation of hypomania or mania in people with bipolar disorder.

Sources

• Auvelity - dextromethorphan hydrobromide, bupropion hydrochloride tablet, multilayer, extended release, DailyMed (2024)

• Auvelity, Axsome Therapeutics, Inc. (2022)

• Dextromethorphan (compound), PubChem

• Bupropion-associated withdrawal symptoms: A case report, Primary Care Companion to the Journal of Clinical Psychiatry (1999)

• Dextromethorphan withdrawal and dependence syndrome, Deutsches Ärzteblatt International (2010)