Bupropion (generic)

Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban (brand)

Classification: Dopamine and norepinephrine reuptake inhibitor antidepressant.

Common usage: Bupropion is indicated for the treatment of major depressive disorder and for symptoms of seasonal affective disorder. It is also indicated for smoking cessation. The safety and effectiveness of bupropion have not been established for patients under age 18.

Contraindications: Using bupropion is not recommended for individuals with a history of a seizure disorder (epilepsy), an eating disorder (bulimia or anorexia), or if recently taking monoamine oxidase inhibitor (MAOI) antidepressants (see “Interactions with Other Medications”).

Warnings:

Suicidality in children and adolescents: Drugs that treat depression increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder and other psychiatric disorders. Bupropion is not approved for use in pediatric patients. Anyone considering the use of bupropion or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on these medications should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the physician.

Notify the prescribing clinician immediately if any of the following develop:

  • Thoughts about suicide or dying.
  • Attempts to commit suicide.
  • New or worsening depression.
  • New or worsening anxiety.
  • Feeling very agitated or restless.
  • Panic attacks.
  • Difficulty sleeping.
  • New or worsening irritability.
  • Acting aggressive or violent, or being angry.
  • Acting on dangerous impulses.
  • An extreme increase in activity or talking.
  • Other unusual changes in behavior or mood.

Seizures: Bupropion is associated with a dose-related risk of seizure, which means the chance of having a seizure increases with higher doses of the medication. Other risk factors for seizures include past injury to the head and medications that can lower the threshold for seizures. It is important that you take your medication as directed and do not take more than one dose at a time. If you experience a seizure while on this treatment, discontinue taking the medication and contact your physician immediately.

Pregnancy: The safety of bupropion in pregnant women and nursing mothers is not established. The potential benefits of bupropion must be weighed against the possible hazards. This drug passes into breast milk and may have undesirable side effects on a nursing infant.

Important side effects: Bupropion is generally well-tolerated by most people. The most commonly reported side effects are loss of appetite, weight loss, dry mouth, skin rash, sweating, ringing in ears, insomnia, headache, constipation, stomach pain, anxiety, agitation, and shakiness. Some patients have reported feeling nausea and others have reported having difficulty sleeping. These side effects are generally mild and disappear after a few weeks. If nausea develops, try taking the medication with food. If you have trouble sleeping, avoid taking bupropion too close to bedtime.

This is not a complete list of all known or potential adverse effects. Notify your prescriber or pharmacist of any symptoms that have started since you began taking this medication, changing its dose, or adding or changing other medication or diet. Take care when performing any task that requires your attention (such as driving or operating machinery) until you have experience with this drug and are confident that you can perform the task safely.

Interactions with other medications:

Bupropion should not be taken with other antidepressants unless specifically recommended by your prescriber. The risk of adverse effects could be increased if bupropion is combined with carbamazepine (Tegretol), clozapine (Clozaril), fluoxetine (Prozac), haloperidol (Haldol), lithium (Eskalith, Lithobid), loxapine (Loxitane), molindone (Moban), phenothiazines, phenytoin (Dilantin), thioxanthenes, or trazodone (Desyrel). Bupropion should not be taken with cimetidine (Tagamet), orphenadrine (Norflex), cyclophosphamide (Cytoxan), or any of the MAOIs, such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). Bupropion also may affect the action of warfarin (Coumadin). Ritonavir (Norvir) may increase the breakdown and elimination of bupropion.

Patients should be made aware that Zyban, used as an aid to stop smoking, contains the same active ingredient found in Wellbutrin, Wellbutrin SR, and Wellbutrin XL, and should not be used in conjunction with these or any other medications that contain bupropion.

This is not a complete list of all known or potential drug interactions. To help prevent problems, always make sure that your pharmacist and all prescribers know about all medications you are taking, including over-the-counter drugs; dietary herbal supplements; folk or home remedies; or unusual foods, drinks, or dietary habits.

Common dosages:

Bupropion immediate-release (Wellbutrin): The recommended initial dose for adults is 200 mg per day, given as 100 mg in the morning and 100 mg in the evening. Based on response, the dose may be increased to 300 mg a day in 100-mg doses three times a day. If your doctor has prescribed the immediate-release formulation for three times a day, do not take all of the day’s tablets at one time.

Wellbutrin sustained-release (SR): The recommended initial dose for adults is a single 150-mg daily dose given in the morning. If that is adequately tolerated, an increase to a 300-mg dose, given as 150 mg twice daily, may be made as early as day four of dosing. There should be an interval of at least eight hours between successive doses.

Wellbutrin extended-release (ER): The recommended initial dose for adults is a single 150-mg daily dose given in the morning. If that is adequately tolerated, an increase to a 300 mg-dose, given once daily, can be made as early as day four of dosing. There should be an interval of at least 24 hours between successive doses.

Sustained-release and extended-release tablets always should be swallowed whole — not chewed, crushed, or dissolved — so that the timed-release mechanism will not be altered. The full antidepressant effect of bupropion may not be felt until four weeks or longer. If you forget to take a dose, take it as soon as you remember, but if it is within eight hours of your next dose, then skip the missed dose. Do not take double doses.

Identification: Wellbutrin immediate-release formulation is available in 75- and 100-mg tablets. The 75-mg tablets are yellow-gold, round, and printed with “Wellbutrin 75.” The 100-mg tablets are red, round, and printed with “Wellbutrin 100.”

Wellbutrin SR is available in 100-, 150-, and 200-mg strength tablets. The 100-mg tablets are blue, round, and printed with “WELLBUTRIN SR 100.” The 150-mg tablets are purple, round, and printed with “WELLBUTRIN SR 150.” The 200-mg tablets are light pink, round, and printed with “WELLBUTRIN SR 200.”

Wellbutrin XL is available in 150- and 300-mg tablets. Both are creamy white to pale yellow and round, printed with either “WELLBUTRIN XL 150” or “WELLBUTRIN XL 300.”

Generic bupropion is available in 150- and 300-mg tablets.

Zyban is available in 150-mg tablets that are purple and round, printed with “ZYBAN 150.”

Storage: Bupropion should be stored at controlled room temperature (68°F to 77°F) in a tightly closed, child-, light-, and moisture-resistant container. If you have difficulty opening child-resistant containers, your pharmacist can provide you with a container that is easier to open. Keep the medication out of direct sunlight and avoid storing it in a warm and humid area, such as the bathroom or kitchen, to avoid deterioration. To prevent accidental poisoning, keep all medications out of the reach of children or adults with dementia. Do not take expired medication. Do not transfer medication from one container to another. Carefully discard discontinued medication where children or adults with dementia cannot find it.