Bupropion

Generic name: Bupropion

Usage of Bupropion

Bupropion is an antidepressant medication used to treat depression and seasonal affective disorder, it also supports smoking cessation and weight management. Bupropion is the active ingredient in Wellbutrin and Zyban, Auvelity contains Bupropion and dextromethorphan, and Contrave contains Bupropion and naltrexone. Bupropion improves mood regulation and nicotine cravings and, when combined with naltrexone, helps reduce food intake.

Bupropion is thought to work by changing levels of certain chemicals in the brain, including noradrenaline and dopamine.

Bupropion first became an FDA-approved medicine on 30 December 1985.

Bupropion side effects

Common bupropion side effects

The most common side effects may include:

dry mouth, sore throat, stuffy nose;

ringing in the ears;

blurred vision;

nausea, vomiting, stomach pain, loss of appetite, constipation;

sleep problems (insomnia);

tremors, sweating, feeling anxious or nervous;

fast heartbeats;

confusion, agitation, hostility;

rash;

weight loss;

increased urination;

headache, dizziness; or muscle or joint pain.

Serious bupropion side effects

Get emergency medical help if you have any of these signs of an allergic reaction to bupropion: (hives, itching, fever, swollen glands, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, depression, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

a seizure (convulsions);

confusion, unusual changes in mood or behavior;

blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;

fast or irregular heartbeats; or

a manic episode - racing thoughts, increased energy, reckless behavior, feeling extremely happy or irritable, talking more than usual, severe problems with sleep.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Before taking Bupropion

Do not use this medicine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

You should not take this medicine if you are allergic to it or if you have ever had:

a seizure disorder;

an eating disorder such as anorexia or bulimia; or

if you have suddenly stopped using alcohol, seizure medication, or a sedative (such as Xanax, Valium, Fiorinal, Klonopin, and others).

Do not take this medicine to treat more than one condition at a time. If you take bupropion for depression, do not also take this medicine to quit smoking or for weight management.

Tell your doctor about all of your medical conditions and the drugs you use.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

a head injury, seizures, or brain or spinal cord tumor;

narrow-angle glaucoma;

heart disease, high blood pressure, or a heart attack;

diabetes;

kidney or liver disease (especially cirrhosis);

depression, bipolar disorder or other mental illness; or

if you drink alcohol.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using this medicine. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Pregnancy

Talk to your healthcare provider if you are pregnant or plan to become pregnant about the risk to your unborn baby. It is not known whether this medicine will harm an unborn baby. Tell your doctor right away if you become pregnant. Do not start or stop taking bupropion without your doctor's advice.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of this medicine on the baby.

Breastfeeding

Tell your healthcare provider if you are breastfeeding or plan to breastfeed while taking this medicine. This medicine passes into breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with this medicine.

How to use Bupropion

Usual Adult Bupropion Dose for Depression:

Immediate-release tablets:

Initial dose: 100 mg orally twice a day, increase if necessary after 3 days to 100 mg orally three times a day.

Maintenance dose: 100 mg orally three times a day

Maximum dose: 450 mg/day in up to 4 divided doses; single doses should not exceed 150 mg

Immediate-release tablets should be given at least 6 hours apart.

Dose increases of the immediate-release tablet should not exceed 100 mg per day in a 3-day period.

Sustained-release tablets:

Initial dose: 150 mg orally once a day in the morning, increase if necessary after 3 days to 150 mg orally twice a day.

Maintenance dose: 150 mg orally twice a day

Maximum dose: 400 mg/day; maximum single dose should not exceed 200 mg

Sustained-release oral tablets should be given at least 8 hours apart

Extended-release tablets:

Initial dose: 150 mg orally once a day in the morning, increase if necessary after 4 days to 300 mg orally once a day.

Maintenance dose: 300 mg orally once a day

Maximum dose: 450 mg/day

Extended-release oral tablets should be given at least 24 hours apart

Comments:

So as not to exceed the maximum single dose of 150 mg for immediate-release tablets, a dose of 100 mg orally four times a day (using the 100 mg tablet) may be administered. Patients who are taking 300 mg/day for at least 2 weeks (OR are currently taking 450 mg/day) of any formulation may be switched to the extended-release 450 mg dose. Bupropion hydrobromide 174 mg oral tablet is equivalent to bupropion hydrochloride 150 mg. Patients should be periodically reviewed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Usual Adult Bupropion Dose for Seasonal Affective Disorder:

Extended-release tablets:

Initial dose: 150 mg orally once a day in the morning, increased if necessary after 7 days to 300 mg orally once a day

Maintenance dose: 150 to 300 mg orally once a day

Maximum dose: 300 mg/day

Comments:

Treatment should be initiated in the autumn prior to the onset of depressive symptoms, continued through the winter season, and discontinued in early spring. If bupropion hydrochloride 300 mg orally per day is not tolerated, it should be reduced to 150 mg once a day before discontinuing treatment. Patients taking bupropion hydrochloride 300 mg orally per day during the autumn-winter season should have their dose tapered to 150 mg once a day for 2 weeks prior to discontinuation. The timing of initiation and treatment duration for seasonal affective disorder should be individualized according to the patient's historical pattern of seasonal major depressive episodes.

Usual Adult Dose for Smoking Cessation:

Sustained-release tablets:

Initial dose: 150 mg orally once a day for 3 days, increased to 150 mg orally twice a day

Maintenance dose: 150 mg orally twice a day

Maximum dose: 300 mg/day; maximum single dose should not exceed 150 mg

Duration of therapy: 7 to 12 weeks

Comments: Begin dosing one week before quit day; the target stop date should be set within the first 2 weeks of treatment, preferably in the second week. There should be an interval of at least 8 hours between doses. May be used with a nicotine transdermal system. If there is no effect after 12 weeks, treatment should be discontinued; longer treatment should be guided by the relative benefits and risks for the individual patient.

Warnings

You should not take bupropion if you have seizures, an eating disorder, or suddenly stopped using alcohol, seizure medication, or sedatives. You should not take two medicines together that contain bupropion for example, if you take Wellbutrin for depression, you should not also take Contrave for weight control.

Do not use bupropion within 14 days before or 14 days after you have used a MAO inhibitors , such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Some young people (up to 24 years of age) have thoughts about suicide when first taking this medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

You should know that your mental health may change in unexpected ways when you take bupropion or other antidepressants even if you are an adult over age 24 or if you do not have a mental illness and you are taking bupropion to treat a different type of condition. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

This medicine may cause seizures, especially in people with certain medical conditions or when using certain drugs. Tell your doctor about all of your medical conditions and the drugs you use.

Bupropion can cause mild pupillary dilation, which can lead to an episode of angle-closure glaucoma in susceptible individuals. Angle-closure glaucoma has occurred in patients with untreated anatomically narrow angles treated with antidepressants.

What other drugs will affect Bupropion

You may have a higher risk of seizures if you use certain other medicines while taking bupropion.

Many drugs can interact with bupropion. Tell your doctor about all medicines you use, and those you start or stop using during your treatment. This includes prescription and over-the-counter medicines, vitamins, and herbal products.

Some examples of drugs that interact with bupropion are:

Digoxin: May decrease plasma digoxin levels. Monitor digoxin levels

MAOIs: Increased risk of hypertensive reactions can occur when used concomitantly with this medication.

Drugs that lower seizure threshold: Dose bupropion with caution.

Medicines that are CYP2B6 inducers: Dose increase may be necessary if coadministered with CYP2B6 inducers (e.g., ritonavir, lopinavir, efavirenz, Carbamazepine, phenobarbital, and phenytoin) based on clinical response, but should not exceed the maximum recommended dose.

Medicines metabolized by CYP2D6: Bupropion inhibits CYP2D6 and can increase concentrations of antidepressants (e.g., venlafaxine, nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, sertraline), antipsychotics (e.g., haloperidol, risperidone, thioridazine), beta-blockers (e.g., metoprolol), and Type 1C antiarrhythmics (e.g., propafenone, flecainide). A dose reduction of these medicines may be considered when used with bupropion.

Dopaminergic drugs (levodopa and amantadine): CNS toxicity can occur when used concomitantly with this medicine.

Not all possible interactions are listed in this medication guide.

Popular FAQ

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Auvelity worked significantly better than Wellbutrin (bupropion) at relieving symptoms of depression in a small randomized double-blind, parallel trial that lasted for 6 weeks. It also had a faster onset of effect, with improvement in the Montgomery-Åsberg Depression Rating Scale (MADRS) score being observed as early as week 1 and differences being statistically significant by week 2. Continue reading

Both Auvelity and Wellbutrin are effective for depression but a small RCT (n=80) reported that Auvelity worked significantly better than Wellbutrin and took less time to start working. 43 people prescribed Auvelity experienced an overall decrease in their Montgomery-Åsberg Depression Rating Scale (MADRS) score of 13.7 points after 6 weeks compared to a decrease of 8.8 points in the 37 people prescribed bupropion (least-squares mean difference=-4.9; 95% CI=-3.1, -6.8). Continue reading

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