Delayed onset urticaria in depressive patients with bupropion prescription: a nationwide population-based study.
BACKGROUND
Bupropion, which is widely used in patients with depressive disorder, may cause allergic reactions. However, the real prevalence of these side effects may be overlooked and underreported due to the delayed onset phenomenon.


OBJECTIVE
This study aimed to estimate the real incidence of bupropion-induced urticaria and clarify the delayed onset phenomenon.


METHODS
We conducted a nationwide cohort study between 2000 and 2009 using Taiwan's National Health Insurance Dataset. Among 65,988 patients with depressive disorders, we identified new users of bupropion with depressive disorders (bupropion cohort, n = 2,839) and matched them at a ratio of 1:4 regarding age and sex (non-bupropion matched cohort, n = 11,356). The risk of urticaria was compared between the two cohorts.


RESULTS
The risk of urticaria occurrence was higher in bupropion users than in matched controls within 4 weeks of starting the medication (risk ratio 1.81; 95% confidence interval 1.28-2.54; p = 0.001). The occurrence of urticaria in the bupropion cohort were more frequent on Days 15-28 than Day 1-14 (p = 0.002). Cox proportional hazards model showed that a history of urticaria was an independent risk factor for developing bupropion-induced urticaria.


CONCLUSIONS
Of the antidepressants, bupropion may pose a higher risk of drug-induced urticaria, and this condition might be ignored due to the delayed onset phenomenon. Depressive patients with a history of urticaria are at higher risk of the adverse drug reaction. This study emphasizes the need for increased clinical awareness of this adverse outcome to bupropion use.
Department of Psychiatry, Kaohsiung Veterans General Veterans Hospital, Kaohsiung, Taiwan ; Department of Psychiatry, Yuli Veterans Hospital, Yuli, Taiwan ; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan ; National Yang-Ming University, Taipei, Taiwan.
Li-Yu
LY
Hu
Chia-Jen
CJ
Liu
Ti
T
Lu
Tsung-Ming
TM
Hu
Chia-Fen
CF
Tsai
Yu-Wen
YW
Hu
Cheng-Che
CC
Shen
Yu-Sheng
YS
Chang
Mu-Hong
MH
Chen
Chung-Jen
CJ
Teng
Huey-Ling
HL
Chiang
Chiu-Mei
CM
Yeh
Vincent Yi-Fong
VY
Su
Wei-Shu
WS
Wang
Pan-Ming
PM
Chen
Tzeng-Ji
TJ
Chen
Tung-Ping
TP
Su
D000328:Adult; D017668:Age of Onset; D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion / Q000009:adverse effects*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014581:Urticaria / Q000139:chemically induced / Q000453:epidemiology* / Q000503:physiopathology
D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion