Bupropion
Generic Name
Bupropion (bue-PROE-pee-on) M
Brand Names
Budeprion Wellbutrin SR
Budeprion XL Wellbutrin XL
Wellbutrin Zyban
Type of Drug
Antidepressant and smoking deterrent.
Prescribed For
Depression, seasonal affective disorder, and nicotine addiction.
General Information
Bupropion is used for major depression and seasonal affective disorder, and may work as a smoking deterrent by acting on key hormone systems in the brain. It works primarily on dopamine and noradrenaline, unlike the SSRI antidepressants, which primarily work on serotonin. Bupropion may not act until you have taken it for 2-4 weeks. The drug clears your system about 2 weeks after you stop taking it.
Cautions and Warnings
Do not take bupropion if you are allergic or sensitive to any of its ingredients.
Antidepressants have been associated with an increased risk of suicide, especially in children and teenagers. Suicide is always a risk in depressed people, who should only be allowed to have minimal quantities of medication in their possession. Clinical worsening of a depressed person’s condition may also occur early
therapy with anticlepressa”kS.
People with seizure disorders, people who have had a seizure in the past, and people with bulimia or anorexia nervosa should be very careful about taking bupropion because they are at a higher risk of having a seizure. About 4 in 1000 people taking bupropion in dosages up to 450 mg a day develop a seizure. The risk of developing a seizure increases by about 10 times with dosages between 450 and 600 mg a day. About half of the people who developed a seizure on bupropion had a risk factor such as a history of head injury, a previous seizure, or a nervous system tumor, or were taking another drug associated with increased seizure risk.
People with unstable heart disease or those who have had a recent heart attack should take this drug with caution because of possible side effects.
Many people taking bupropion experience some restlessness, agitation, anxiety, and sleeplessness, especially soon after they start taking the drug. Some even require sleeping pills to counter this effect, and others find the stimulation so severe that they have to stop taking bupropion.
Bupropion may trigger a manic episode in those with depression or bipolar disorder.
People taking bupropion may experience hallucinations, delusions, or psychotic episodes. Dosage reduction or drug withdrawal is usually necessary to manage these reactions.
One-quarter of those who take bupropion lose their appetite and 5 or more lbs. of body weight. People who have lost weight due to their depression should be cautious about taking bupropion.
People switching from bupropion to a monoamine oxidase inhibitor (MA01) antidepressant, or vice versa, should allow at least 2 weeks to pass between stopping one drug and starting the other.
People with kidney or liver disease require less bupropion at the beginning of treatment. Dosage should be increased cautiously.
An antidepressant other than bupropion should be seriously considered for people with a history of drug abuse because of the mild stimulation bupropion causes. These people may require larger-than-usual dosages, but they are still susceptible to seizures at these higher dosages.
Possible Side Effects
About 10% of people stop taking bupropion due to side effects.
♦ Most common: dry mouth; dizziness; rapid heartbeat; headache, including migraine; excessive sweating; nausea; vomiting; constipation; appetite loss; weight changes: sedation; agitation; sleeplessness; and tremors.
Possible Side Effects (continued)
V Less common’. upset stomach, diarrhea, increased appetite, menstrual complaints, impotence, urinary difficulties, slowness of movement, salivation, muscle spasms, warmth, uncontrolled muscle movement, compulsion to move around or change positions, abnormal heart rhythms, blood-pressure changes, heart palpitations, fainting, itching, redness and rash, confusion, hostility, loss of concentration, reduced sex drive, anxiety, delusions, euphoria (feeling “high”), fatigue, joint pain, fever or chills, respiratory infection, and visual, taste, and hearing disturbances.
Drug Interactions
• Phenelzine (an MAGI) increases the risk of bupropion side effects. Allow at least 2 weeks to pass between stopping an MAGI and starting bupropion. Serious side effects can occur.
• Carbamazepine may reduce blood concentrations of bupropion.
• People taking both bupropion and levodopa + carbidopa or amantadine experience increased side effects. People taking these drugs should have their bupropion dosage increased gradually.
• Ritonavir may significantly increase bupropion blood levels and the risk of side effects.
• Don’t mix bupropion with other drugs that increase the risk of seizures—including tricyclic antidepressants, haloperidol, lithium, loxapine, molindone, phenothiazine sedatives, and thioxanthene sedatives.
• Combining bupropion with a nicotine replacement drug can cause high blood pressure.
• Combining bupropion with warfarin can increase the risk of side effects.
• Do not comtImP. INO~bujfin and Zyban, as they contain the same active ingredient.
• Alcohol should be avoided by people taking bupropion.
Food Interactions
Bupropion may be taken with food if it upsets your stomach.
Usual Dose
Depression
Adult: 200-450 mg a day; normal daily dosage is 300 mg. Child (under age 18): not recommended.
Smoking Cessation
Adult: 150 mg twice a day. Begin treatment while you are still
smoking.
Child (under age 18): not recommended.
Overdosage
Symptoms of overdose are likely to include severe side effects, such as seizures—present in a third of overdoses—hallucinations, loss of consciousness, and abnormal heart rhythms. Overdose victims should be taken to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Do not stop taking bupropion without your doctor’s knowledge. Suddenly stopping the drug may cause withdrawal reactions and side effects.
Call your doctor if you experience agitation or excitement, restlessness, confusion, difficulty sleeping, anxiety, panic attacks, sleeplessness, irritability, hostility, aggressiveness, acting impulsively, a manic reaction, deepening depression, suicidal thinking, fast or abnormal heart rhythm, severe headache, seizure, rash, fainting, or any unusual or persistent side effect.
Bupropion may make you tired, dizzy, or lightheaded. Be careful when driving or doing any task that requires concentration.
Alcohol, sedatives, and other nervous system depressants increase the depressant effects of this drug. Alcohol also increases the risk of a seizure.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose and you take it several times a day, take 1 dose as soon as you remember and another in 3 or 4 hours, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of using bupropion during pregnancy is not known. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks. Pregnant women trying to quit smoking should use non-drug methods until their pregnancy is completed.
Bupropion passes into breast milk. Nursing mothers who must use bupropion should use infant formula.
Seniors: Seniors with reduced kidney or liver function may require reduced dosage.