Development of oral candidiasis following initiation and rechallenge of extended-release bupropion in a geriatric patient

Objective: To report a case of oral candidiasis that developed in a 70-year-old white female both upon initiation and rechallenge of extended-release bupropion therapy. Case Summary: A 70-year-old female with a past medical history of osteoarthritis, degenerative joint disease, and polycythemia vera developed oral candidiasis on 2 occasions following initiation of extended-release bupropion for the treatment of recurrent depression. During both instances, the reaction occurred with an increased dose of the medication, suggesting the adverse event may have been dose-related. The patient had no risk factors for oral candidiasis aside from dry mouth at baseline that reportedly worsened on bupropion. Discussion: Though there are no other reports to our knowledge describing the development of oral candidiasis with bupropion, the likelihood of this having been an adverse reaction in this patient is probable as indicated by a calculated score of 8 from the Naranjo Algorithm. The adverse event appeared following bupropion administration and improved over time following its discontinuation. The adverse event reappeared following readministration of the agent, and no alternative causes were able to be identified. Additionally, the reaction occurred following an increase in the dose on both occasions, with the lower dose having only resulted in worsening dry mouth. Conclusion: This case demonstrates that an additional adverse event to screen for with bupropion treatment is the development of oral candidiasis. This adverse event may be more likely to occur in the older adult population.