Auvelity (Dextromethorphan-Bupropion): How This Antidepressant Works and When Telehealth Is Enough

Last updated: August 20, 2026

Auvelity is a prescription combination of dextromethorphan hydrobromide and bupropion hydrochloride. Clinicians use it for major depressive disorder (MDD) in adults. It is not an SSRI and it is not a controlled substance. The bupropion piece is the same active ingredient found in Wellbutrin-class products, so you cannot stack Auvelity with another bupropion product. Coverage, prior authorization, and whether a brand-only tablet is on formulary vary by plan. Verify benefits before you book.

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TLDR

• Auvelity pairs dextromethorphan (an NMDA receptor antagonist and sigma-1 agonist) with bupropion (an aminoketone that also inhibits CYP2D6), per the DailyMed Auvelity label.
• MedlinePlus describes the usual adult start as once daily for 3 days, then twice daily at least 8 hours apart. Swallow tablets whole.
• NAMI notes tablet strength 45 mg dextromethorphan / 105 mg bupropion, and that some people notice benefit after about one week of use.
• DailyMed contraindicates seizure disorder, current or prior bulimia or anorexia nervosa, abrupt stop of alcohol or benzodiazepines, MAOI use within 14 days, and known hypersensitivity.
• Medicare behavioral/mental telehealth in the home is permanent. The in-person visit waiver for Medicare behavioral telehealth runs through December 31, 2027, per HHS telehealth policy updates.
• Klarity Health has 2,000+ licensed providers. Insurance may help with visits and prescriptions; it varies by plan.

What is Auvelity?

Auvelity is an extended-release tablet that contains two medicines. Dextromethorphan is best known as a cough suppressant. In this product it acts as an uncompetitive NMDA receptor antagonist and a sigma-1 receptor agonist. Bupropion is an antidepressant that also slows CYP2D6, which raises dextromethorphan levels so more of it stays available. That is why you should not take extra cough syrup that already contains dextromethorphan, and why you should not take Wellbutrin, Aplenzin, Forfivo, or Zyban at the same time.

MedlinePlus lists the combination as a treatment for depression. NAMI lists the FDA indication as MDD. DailyMed also lists a separate indication for agitation associated with dementia due to Alzheimer’s disease, with a slower titration and a statement that the drug is not an as-needed (PRN) treatment for that agitation. This article focuses on adult depression care, which is the use case most people search when they type Auvelity.

People often compare Auvelity with Wellbutrin (bupropion), Trintellix (vortioxetine), Lexapro, Zoloft, Prozac, Cymbalta, and Effexor. Those are different classes. A licensed clinician decides whether an NMDA-modulating combination, an SSRI, an SNRI, or bupropion alone is the better next step.

How should you take Auvelity?

For MDD, DailyMed sets the start at one 45 mg/105 mg tablet once daily in the morning. On day 4, the maximum recommended dosage is one tablet twice daily, at least 8 hours apart. Do not take more than two doses in one day. Swallow whole. Do not crush, split, or chew.

If you have moderate renal impairment, DailyMed caps the dose at one tablet once daily in the morning. CYP2D6 poor metabolizers use the same once-daily cap. Strong CYP2D6 inhibitors (examples NAMI lists include paroxetine and fluoxetine) also push the label toward once daily. Avoid strong CYP2B6 inducers. Avoid Auvelity in severe hepatic impairment.

Missed dose: NAMI says skip the missed tablet. Do not double up. Do not take more than two tablets in 24 hours.

If you stop suddenly, MedlinePlus warns you may get mood changes, agitation, dizziness, ringing in the ears, shock-like sensations, anxiety, insomnia, numbness, headache, sweating, seizures, or nausea. Talk with the prescribing clinician before you stop.

Who should not take Auvelity?

DailyMed contraindications:

• Seizure disorder
• Current or prior diagnosis of bulimia or anorexia nervosa
• Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
• MAOI use, or starting Auvelity within 14 days of stopping an MAOI (and do not start an MAOI within 14 days of stopping Auvelity)
• Known hypersensitivity to bupropion, dextromethorphan, or tablet components

NAMI also flags seizure risk with higher-than-recommended doses, head injury, brain tumor, severe liver disease, eating disorders, alcohol or drug dependence, and other drugs that lower the seizure threshold (tricyclics, antipsychotics, theophylline, isoniazid, tramadol, stimulants, steroids, insulin and other hypoglycemics, some antibiotics such as ciprofloxacin, and abrupt benzodiazepine withdrawal).

Do not combine with other bupropion products or other dextromethorphan cough products. DailyMed notes the tablet can cause false-positive urine amphetamine tests.

Side effects and boxed warning

The label carries the standard antidepressant boxed warning on suicidal thoughts and behaviors. MedlinePlus stresses that Auvelity is not approved under age 18, and that mood can change even in adults, especially when treatment starts or the dose changes. If you or someone you care for has thoughts of suicide, call 988 or go to an emergency department.

DailyMed lists the most common MDD adverse reactions (≥5% and more than twice placebo) as dizziness, headache, diarrhea, somnolence, dry mouth, sexual dysfunction, and hyperhidrosis. NAMI adds that dizziness and sleepiness can impair driving until you know how you respond.

Other label warnings: blood pressure can rise, so check it before start and during treatment; mania or hypomania can emerge, so screen for bipolar disorder; psychosis and other neuropsychiatric reactions; angle-closure glaucoma in people with untreated narrow angles; serotonin syndrome when combined with SSRIs, tricyclics, linezolid, triptans, tramadol, and similar serotonergic drugs; embryo-fetal toxicity (DailyMed and NAMI advise against use in pregnancy and against breastfeeding during treatment and for five days after the last dose); hyponatremia/SIADH.

When is telehealth enough?

Auvelity is a non-scheduled oral tablet. Many follow-up visits for adult MDD medication management can happen by video. A clinician still needs a full history: seizure risk, eating-disorder history, blood pressure, other bupropion or dextromethorphan products, MAOIs, kidney function, and pregnancy plans.

HHS states that Medicare patients can permanently receive behavioral/mental telehealth in the home, with no geographic originating-site restriction, and that audio-only is permanently allowed for behavioral/mental telehealth. The requirement for an in-person visit within six months of an initial Medicare behavioral telehealth service, and annually after that, is waived through December 31, 2027.

Klarity is not a substitute for emergency care, REMS-clinic treatments such as Spravato, or inpatient psychiatry. If you need online depression treatment, a licensed provider in the 2,000+ Klarity network can review whether Auvelity, another antidepressant, or a different plan is appropriate. Insurance may cover part of the visit or the drug. It often does not. Ask your plan.

How Auvelity compares with other depression medicines

Unlike Celexa, Paxil, or mirtazapine, Auvelity is a two-drug NMDA/CYP2D6 combination. Unlike Pristiq, it is not an SNRI. Unlike bupropion alone, it adds dextromethorphan and a twice-daily schedule after day 3. Brand Auvelity is often a higher formulary tier with prior authorization. Generic SSRIs and SNRIs are typically easier to fill. None of that means one drug is “better.” It means the access path and monitoring look different.

Insurance, cost, and what to verify

Plans may place Auvelity on a specialty or non-preferred brand tier. Step therapy through an SSRI, SNRI, or generic bupropion is common. Copays and prior authorization rules vary. Klarity cannot promise coverage. Read your formulary, call the PBM, and confirm the NDC your pharmacy will dispense.

Disclaimer: This article is education, not medical advice and not a coverage determination. Treatment decisions belong to you and a licensed clinician. Coverage varies by plan. Verify benefits before you book. If you are in crisis, call or text 988.

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Sources

• MedlinePlus: Dextromethorphan and Bupropion
• NAMI: Dextromethorphan and Bupropion (Auvelity)
• DailyMed: AUVELITY prescribing information
• HHS: Telehealth policy updates