People should not take Auvelity for Alzheimer’s agitation if they have a seizure disorder; a current or past diagnosis of anorexia nervosa or bulimia; an allergy to dextromethorphan, bupropion, or another ingredient in the drug; or are abruptly stopping alcohol, benzodiazepines, barbiturates, or antiseizure medication. It is also contraindicated during treatment with a monoamine oxidase inhibitor, or MAOI, and for 14 days after stopping one. For example, a person who recently took the MAOI phenelzine—or who needs the antibiotic linezolid—should not start Auvelity because the interaction can cause a hypertensive crisis or serotonin syndrome.
Other people may not be suitable candidates even when they do not have a formal contraindication. These include patients with severe kidney or liver impairment, untreated narrow-angle glaucoma, poorly controlled high blood pressure, substantial fall risk, low sodium, bipolar disorder, or complex medication regimens that raise the risk of seizures or serotonin syndrome. Auvelity was approved by the FDA in April 2026 for agitation associated with dementia due to Alzheimer’s disease in adults, but it is not an as-needed rescue drug and does not slow Alzheimer’s disease or restore memory.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Who Should Not Take Auvelity for Alzheimer’s Agitation?
- Seizure Risk and Conditions That Can Make Auvelity Unsafe
- MAOIs, Antidepressants, Cough Medicines, and Other Interactions
- What Caregivers Should Check Before Auvelity Is Started
- Falls, Blood Pressure, Low Sodium, and Neuropsychiatric Problems
- Pregnancy, Breastfeeding, and Use Outside the Adult Alzheimer’s Indication
- Kidney and Liver Impairment, Titration, and Tablet Administration
- Frequently Asked Questions
Who Should Not Take Auvelity for Alzheimer’s Agitation?
The clearest “do not take” categories come from the FDA-approved Auvelity prescribing information. Auvelity is contraindicated in anyone with a seizure disorder. It is also contraindicated in people who currently have—or have ever been diagnosed with—bulimia or anorexia nervosa because bupropion, one of Auvelity’s two active ingredients, can increase seizure risk. A remote eating-disorder history still matters: an 80-year-old who had bulimia in early adulthood should tell the prescriber even if the condition has been inactive for decades. A previous serious reaction to bupropion, dextromethorphan, or another tablet ingredient is another reason not to use Auvelity.
Reported hypersensitivity reactions associated with bupropion include anaphylactic reactions and severe skin reactions such as Stevens-Johnson syndrome. A past mild side effect, such as dry mouth, is not the same as an allergy, but facial swelling, breathing difficulty, blistering skin, or a widespread rash requires a very different level of caution. Auvelity is specifically approved for agitation associated with dementia due to Alzheimer’s disease. A person whose agitation comes from delirium, medication toxicity, Lewy body dementia, vascular dementia, or an untreated illness needs an evaluation rather than an assumption that the Alzheimer’s indication applies. Compared with a drug that modifies Alzheimer’s pathology, Auvelity targets an associated behavioral symptom; it is not a treatment for the underlying neurodegenerative process.
Seizure Risk and Conditions That Can Make Auvelity Unsafe
Bupropion can cause seizures, and that risk increases with dose. Beyond diagnosed seizure disorders, prescribers need to consider factors that lower the seizure threshold, including a serious head injury, brain tumor, severe stroke, central nervous system infection, metabolic disturbances, low blood sugar treated with insulin or certain diabetes drugs, low sodium, and heavy alcohol or sedative use. Other medicines can add to the risk, including some antipsychotics, antidepressants, systemic corticosteroids, stimulants, and theophylline. Abrupt withdrawal is especially important.
A caregiver should not suddenly stop nightly lorazepam, a barbiturate, an antiseizure drug, or regular heavy alcohol use simply to make the person “eligible” for Auvelity. Withdrawal itself can provoke seizures and is listed among the drug’s contraindications. Any taper must be planned and supervised by a clinician familiar with the person’s dose, duration of use, and medical history. If a seizure occurs during Auvelity treatment, the prescribing information says to discontinue the drug and not restart it. A brief staring episode, sudden unexplained collapse, rhythmic jerking, or loss of awareness warrants prompt medical assessment; seizures in older adults do not always look like the dramatic whole-body convulsions caregivers expect.
MAOIs, Antidepressants, Cough Medicines, and Other Interactions
MAOIs must not be combined with Auvelity. This includes older antidepressants such as phenelzine, tranylcypromine, and isocarboxazid, as well as MAOI drugs used in other settings. Linezolid and intravenous methylene blue are specifically important because they may be given during treatment for an infection or hospital procedure. At least 14 days must pass after stopping an MAOI before Auvelity begins, and at least 14 days must pass after stopping Auvelity before an MAOI antidepressant begins. Dextromethorphan affects serotonin signaling, so combining Auvelity with serotonergic drugs can cause serotonin syndrome. SSRIs, SNRIs, tricyclic antidepressants, tramadol, and certain migraine medicines may be relevant.
These combinations are not all automatically prohibited, but they require a deliberate prescriber review and monitoring. For example, adding Auvelity to fluoxetine while a caregiver continues giving an over-the-counter dextromethorphan cough syrup could create more risk than any one item on the medication list suggests. Duplicate ingredients are easy to miss. Bupropion is sold for depression and smoking cessation, while dextromethorphan appears in numerous cough and cold products. Auvelity also inhibits the CYP2D6 enzyme and can change exposure to other medicines; strong CYP2D6 inhibitors may require a lower Auvelity dosing schedule. It may reduce digoxin levels, and use with levodopa or amantadine can contribute to restlessness, tremor, poor coordination, gait disturbance, vertigo, or dizziness. A complete review should include prescriptions, nonprescription products, supplements, nicotine-replacement products, and medicines used only occasionally.
What Caregivers Should Check Before Auvelity Is Started
A pre-treatment review should cover blood pressure, seizure history, eating-disorder history, bipolar disorder, previous drug reactions, kidney and liver function, falls, glaucoma, alcohol use, and every medication in the home. The prescriber should specifically look for products containing bupropion or dextromethorphan. Bringing the actual bottles or pharmacy printout is often more reliable than trying to recall names during an appointment. New or suddenly worse agitation also needs a search for reversible causes. The National Institute on Aging identifies pain, constipation, poor sleep, stress, environmental disruption, and medication effects among possible contributors.
A person who begins pacing and shouting during a urinary infection or after developing dental pain may need treatment for that problem, not immediate escalation of a long-term psychiatric medicine. A sudden, fluctuating change accompanied by fever, marked sleepiness, weakness, breathing trouble, or inability to drink requires prompt medical evaluation. Auvelity must be scheduled and titrated; it is not approved for use only when a difficult episode occurs. That limitation matters in real life. Giving a tablet during an aggressive outburst is not comparable to administering a fast-acting rescue medicine, and an extra unscheduled dose can increase adverse effects. Environmental changes—reducing noise, addressing hunger or toileting needs, avoiding arguments, and restoring a familiar routine—can be used immediately while the clinical cause is assessed.
Falls, Blood Pressure, Low Sodium, and Neuropsychiatric Problems
Dizziness is a significant concern in people with dementia. In the short-term controlled Alzheimer’s agitation study described in the prescribing information, dizziness occurred in 9% of Auvelity-treated patients and 3% of those receiving placebo. A person who already uses furniture for support, has neuropathy, or has fallen on the way to the bathroom may face a meaningful tradeoff between improved agitation and greater injury risk. Care plans may need better lighting, supervised transfers, removal of loose rugs, and closer observation after dose increases. Bupropion can raise blood pressure and trigger mania or hypomania in susceptible people. Blood pressure should be checked before treatment and periodically afterward, particularly when hypertension is already present or nicotine replacement is being used.
A personal or family history of bipolar disorder, mania, hypomania, depression, or suicide should be discussed before the first dose. New sleeplessness, unusually rapid speech, expansive mood, impulsivity, hallucinations, paranoia, or sharply increased confusion should not simply be attributed to dementia progression. Older adults may also be more vulnerable to hyponatremia, meaning an abnormally low blood sodium level. Risk can be higher with diuretics, volume depletion, or another serotonergic antidepressant. Symptoms such as headache, weakness, worsening confusion, poor concentration, and unsteadiness can resemble ordinary dementia or frailty; severe cases can involve fainting, seizures, coma, or respiratory arrest. Auvelity should also be avoided in people with untreated anatomically narrow eye angles because antidepressant-related pupil dilation may provoke an angle-closure glaucoma attack. Sudden eye pain, blurred vision, halos around lights, nausea, or a red eye requires urgent care.
Pregnancy, Breastfeeding, and Use Outside the Adult Alzheimer’s Indication
Although most people with Alzheimer’s dementia are older, early-onset disease makes reproductive considerations relevant in uncommon cases. Auvelity is not recommended during pregnancy because animal findings indicate potential fetal harm, and the label advises discontinuation if pregnancy occurs. Someone planning pregnancy should discuss an alternative treatment rather than stopping prescribed medication without a coordinated plan.
Breastfeeding is not recommended during Auvelity treatment or for five days after the final dose. The drug’s safety and effectiveness have not been established in children, and it is not approved for pediatric use. For example, Auvelity prescribed to an adult should never be shared with a younger relative who has behavioral symptoms or depression.
Kidney and Liver Impairment, Titration, and Tablet Administration
Auvelity is not recommended for severe kidney impairment, defined in the label as an estimated glomerular filtration rate of 15 to 29 mL/minute/1.73 m², because its pharmacokinetics have not been evaluated in that group. Moderate kidney impairment requires a lower maximum schedule. The drug is also not recommended in severe hepatic impairment; mild or moderate hepatic impairment does not carry the same label restriction. An older adult’s previous dose should therefore not be copied for a spouse whose kidney or liver function is different.
For Alzheimer’s agitation, the labeled starting dose is one 30 mg/105 mg tablet each morning. On day eight, it may increase to 30 mg/105 mg twice daily, at least eight hours apart, based on tolerability; on day 15, it may increase to 45 mg/105 mg twice daily under the same conditions. Moderate kidney impairment, strong CYP2D6 inhibition, or known poor CYP2D6 metabolism changes that schedule and lowers the maximum to once daily. The extended-release tablets must be swallowed whole—not crushed, divided, or chewed—so a person with swallowing difficulty needs a different medication plan rather than crushed Auvelity hidden in food.
Frequently Asked Questions
Can someone with a past seizure take Auvelity?
Auvelity is contraindicated in anyone with a seizure disorder. The prescriber also needs to evaluate other events that might have been seizures, such as unexplained blackouts or episodes of lost awareness.
Is an SSRI an absolute reason not to take Auvelity?
Not necessarily, but combining Auvelity with an SSRI or another serotonergic medicine raises the risk of serotonin syndrome. The prescriber must evaluate the combination, dose, alternatives, and monitoring plan.
Can Auvelity be given only during severe agitation?
No. The FDA-approved labeling states that Auvelity is not indicated as an as-needed treatment for agitation associated with Alzheimer’s dementia.
Should Auvelity be stopped if it causes dizziness?
Dizziness should be reported promptly, particularly after a fall or near-fall. The prescriber should decide whether to slow titration, adjust interacting medicines, change the dose, or discontinue treatment.
Can Auvelity tablets be crushed for a person with swallowing problems?
No. The extended-release tablets must be swallowed whole and should not be crushed, divided, or chewed. A clinician or pharmacist should identify another workable option.
