bupropion

Bupropion (Wellbutrin) is an antidepressant that affects brain chemicals used for message transmission. It works by inhibiting dopamine, serotonin, and norepinephrine reuptake, resulting in increased transmission.

Bupropion is used to manage major depression and seasonal affective disorder. It is also prescribed for smoking cessation.

Unlike other antidepressants, bupropion mainly affects dopamine and is not associated with SSRIs or TCAs. It was FDA approved in December 1985.

What are the side effects of bupropion (Wellbutrin)?

WARNING

Four in 1000 individuals receiving bupropion may experience seizures, especially at doses above 450 mg/day. Other risk factors include head injury and certain medications.

Antidepressants may increase the risk of suicidal thoughts and behavior in children and adolescents. Patients starting bupropion should be closely observed for worsening symptoms and changes in behavior.

The most common side effects include agitation or insomnia at the beginning of treatment.

Less common side effects include weight loss, rash, and increased heart rate.

More serious side effects include high blood pressure, hallucinations, paranoia, and confusion.

QUESTION

What is the dosage for bupropion (Wellbutrin)?

Bupropion immediate-release tablets are usually given in one, two, or three daily doses. No single dose should exceed 150 mg.

Depression

For depression, the recommended dose is 100 mg three times daily (300 mg/day); the maximum dose is 450 mg/day. The initial dose is 100 mg twice daily, which may be increased to 100 mg three times daily if needed.

Sustained-release tablets: initial dose is 150 mg daily, target dose is 150 mg twice daily, maximum dose is 200 mg twice daily.

Extended-release tablets: initial dose is 150 mg daily, target dose is 300 mg daily, maximum dose is 450 mg daily.

Some patients may require higher doses or a switch to bupropion hydrobromide (Aplenzin), based on their doctor’s recommendation.

Smoking cessation

For smoking cessation, bupropion (Zyban) is started at 150 mg once daily for three days, then increased to 150 mg twice daily. Smoking should be discontinued two weeks after starting treatment.

Seasonal affective disorder

The dose for seasonal affective disorder is 150 mg daily up to 300 mg daily using extended-release tablets such as Wellbutrin XL. Treatment is started in the autumn and continued through the winter.

What drugs interact with bupropion (Wellbutrin)?

Bupropion should be used cautiously with drugs that lower the seizure threshold, such as prochlorperazine and chlorpromazine. Benzodiazepine withdrawal increases the risk of seizures.

Carbamazepine may reduce the effect of bupropion, while combining MAOIs with bupropion can cause severe reactions. A 14-day interval is recommended between discontinuing an MAOI and starting bupropion. Ritonavir may increase the breakdown and elimination of bupropion.

Is bupropion (Wellbutrin) safe during pregnancy or breastfeeding?

There are no adequate studies of bupropion in pregnant women. It should only be used if the benefits outweigh the potential risks.

Bupropion is secreted in breast milk.

What else should I know about bupropion (Wellbutrin)?

Preparations

Bupropion is available under various brand names in the US, with different formulations and combinations. Commonly available formulations include immediate-release, sustained-release, extended-release tablets, and hydrobromide formulations.

Other considerations

Keep tablets at room temperature between 15-25°C (59-77°F). Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban, Aplenzin, Forfivo XL, and Zyban are brand names for bupropion. It is also available as a generic drug.

Summary

Bupropion (Wellbutrin, Zyban, Aplenzin, Forfivo XL) is an antidepressant used for depressive disorders and smoking cessation. Off-label uses include PTSD, anxiety, ADHD, and neuropathic pain. Discuss side effects, drug interactions, pregnancy information, and dosage with your doctor before starting any medication.