Delayed onset urticaria in depressive patients with bupropion prescription: A nationwide population-based study

Li Yu Hu, Chia Jen Liu, Ti Lu, Tsung Ming Hu, Chia Fen Tsai, Yu Wen Hu, Cheng Che Shen, Yu Sheng Chang, Mu Hong Chen, Chung Jen Teng, Huey Ling Chiang, Chiu Mei Yeh, Vincent Yi Fong Su, Wei Shu Wang, Pan Ming Chen, Tzeng Ji Chen, Tung Ping Su

Research output: Contribution to journalArticle

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Abstract

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 (nonbupropion 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.

Original languageEnglish
Article numbere80064
JournalPLoS One
Volume8
Issue number11
DOIs
Publication statusPublished - Nov 14 2013

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urticaria
Bupropion
Urticaria
Prescriptions
Population
Depressive Disorder
health insurance
drugs
Health insurance
antidepressants
relative risk
cohort studies
National Health Programs
hypersensitivity
drug therapy
Drug-Related Side Effects and Adverse Reactions
Taiwan
Proportional Hazards Models
confidence interval
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Hu, L. Y., Liu, C. J., Lu, T., Hu, T. M., Tsai, C. F., Hu, Y. W., ... Su, T. P. (2013). Delayed onset urticaria in depressive patients with bupropion prescription: A nationwide population-based study. PLoS One, 8(11), [e80064]. https://doi.org/10.1371/journal.pone.0080064

Delayed onset urticaria in depressive patients with bupropion prescription : A nationwide population-based study. / Hu, Li Yu; Liu, Chia Jen; Lu, Ti; Hu, Tsung Ming; Tsai, Chia Fen; Hu, Yu Wen; Shen, Cheng Che; Chang, Yu Sheng; Chen, Mu Hong; Teng, Chung Jen; Chiang, Huey Ling; Yeh, Chiu Mei; Su, Vincent Yi Fong; Wang, Wei Shu; Chen, Pan Ming; Chen, Tzeng Ji; Su, Tung Ping.

In: PLoS One, Vol. 8, No. 11, e80064, 14.11.2013.

Research output: Contribution to journalArticle

Hu, LY, Liu, CJ, Lu, T, Hu, TM, Tsai, CF, Hu, YW, Shen, CC, Chang, YS, Chen, MH, Teng, CJ, Chiang, HL, Yeh, CM, Su, VYF, Wang, WS, Chen, PM, Chen, TJ & Su, TP 2013, 'Delayed onset urticaria in depressive patients with bupropion prescription: A nationwide population-based study', PLoS One, vol. 8, no. 11, e80064. https://doi.org/10.1371/journal.pone.0080064
Hu, Li Yu ; Liu, Chia Jen ; Lu, Ti ; Hu, Tsung Ming ; Tsai, Chia Fen ; Hu, Yu Wen ; Shen, Cheng Che ; Chang, Yu Sheng ; Chen, Mu Hong ; Teng, Chung Jen ; Chiang, Huey Ling ; Yeh, Chiu Mei ; Su, Vincent Yi Fong ; Wang, Wei Shu ; Chen, Pan Ming ; Chen, Tzeng Ji ; Su, Tung Ping. / Delayed onset urticaria in depressive patients with bupropion prescription : A nationwide population-based study. In: PLoS One. 2013 ; Vol. 8, No. 11.
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abstract = "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 (nonbupropion 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.",
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AU - Hu, Tsung Ming

AU - Tsai, Chia Fen

AU - Hu, Yu Wen

AU - Shen, Cheng Che

AU - Chang, Yu Sheng

AU - Chen, Mu Hong

AU - Teng, Chung Jen

AU - Chiang, Huey Ling

AU - Yeh, Chiu Mei

AU - Su, Vincent Yi Fong

AU - Wang, Wei Shu

AU - Chen, Pan Ming

AU - Chen, Tzeng Ji

AU - Su, Tung Ping

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N2 - 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 (nonbupropion 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.

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