Bupropion

(byu-pro-pee-on)

Trade/other name(s): Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban, bupropion hydrochloride

Why would this drug be used?

Bupropion is an antidepressant used to help treat depression and some other mental health problems (under the brand names Wellbutrin, Wellbutrin SR, and Wellbutrin XL). It is also used to help people quit smoking (under the brand name Zyban).

How does this drug work?

Bupropion is not like most other antidepressant drugs. The way it works is not completely understood, but it seems to work by acting on levels of certain chemicals (norepinephrine and dopamine) in the brain.

Before taking this medicine

Tell your doctor…

• If you are allergic to any medicines, dyes, additives, or foods.
• If you have ever thought about or attempted suicide. Treatment with an antidepressant may raise the risk of suicidal thoughts, especially during the first few months of treatment.
• If you have ever had schizophrenia, bipolar illness, major depression, or other serious mental health problem. Bupropion may make them worse.
• If you have ever had seizures, or if you have a head injury, brain tumor, or other condition that raises your risk of seizures. This drug may raise your risk of seizures and should be used with extreme caution in people who have had them before.
• If you have ever had an eating disorder (anorexia or bulimia) or are addicted or being treated for addiction to alcohol, sedatives, or other drugs. This drug may raise the risk of seizures in people in these situations.
• If you have ever had liver disease (including hepatitis or cirrhosis). This drug is cleared from the body mainly by the liver. Reduced liver function may result in more drug than expected staying in the body. This could lead to unwanted side effects, including a higher risk of seizures. Your doctor will want to monitor you closely and may need to adjust your dose.
• If you have ever had kidney disease. Your doctor will want to monitor you closely and may need to adjust your dose accordingly.
• If you have ever had high blood pressure or heart disease. This drug may raise the risk of high blood pressure, which in turn might affect a number of heart conditions.
• If you have any other medical conditions such as congestive heart failure, lung disease, diabetes, gout, or infections. You may need closer monitoring of these conditions while being treated.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. It is not known if this drug might cause problems if it is taken it at the time of conception or during pregnancy. It is important to check with your doctor about whether birth control should be used with this medicine.
• If you are breast-feeding. This drug passes into breast milk and may affect the baby. Talk with your doctor about the possible risks of breast-feeding while taking this drug.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Because of the way bupropion is broken down in the liver, it may interact with a large number of other drugs.

Antidepressants known as monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), or selegiline (Emsam) may raise the risk of side effects and should not be taken within 2 weeks of taking bupropion.

Other drugs that may affect the level of bupropion in the body include:

• anti-seizure drugs (carbamazepine, phenytoin, phenobarbital)
• other antidepressants (sertraline, paroxetine, fluoxetine, fluvoxamine)
• anti-HIV drugs (nelfinavir, ritonavir, efavirenz)
• some chemotherapy drugs (cyclophosphamide, thiotepa)
• cimetidine (Tagamet)

Bupropion may affect the levels and actions of some other drugs in the body, including

• tamoxifen may have less effect
• other antidepressants (sertraline, paroxetine, fluoxetine, nortriptyline, imipramine, desipramine)
• antipsychotics such as haloperidol (Haldol), resperidone (Risperdal), and thioridazine (Mellaril)
• beta-blockers (metoprolol)
• heart rhythm drugs such as propafenone (Tambocor) or flecainide (Rhythmol)

Levodopa and amantadine may also raise the risk of side effects from bupropion.

Some drugs may further raise the risk of seizures, including some antidepressants, antipsychotics, steroids, and theophylline.

There may be other drug interactions not on the lists above. Check with your doctor, nurse, or pharmacist about all of your medicines, herbs, and supplements.

Interactions with foods

Alcohol may increase the risk of seizures and other ill effects if used while taking bupropion. Its use should be minimized or avoided while taking this drug.

No other serious interactions with foods are known at this time. Check with your doctor, nurse, or pharmacist about whether these or other foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Bupropion is taken as a pill. It is available in short-acting (Wellbutrin), sustained release (Wellbutrin SR, Zyban), and extended release tablets (Wellbutrin XL).

• The short-acting pills (Wellbutrin) are usually taken twice a day, morning and night, for 3 days to start and then 3 times a day as directed by your doctor.
• The sustained release pills (Wellbutrin SR, Zyban) are usually taken once a day in the morning for a few days to start. If you are doing okay with this dose, your doctor will usually increase the dose so you take 1 pill in the morning and 1 in the evening. For help with quitting smoking (Zyban), bupropion is usually taken for at least 7 to 12 weeks, starting 1 week before your quit date.
• The extended release pills (Wellbutrin XL) are usually taken once a day in the morning. The dose may be increased after 3 days if you don't have problems with the starting dose.

The sustained-release and extended-release forms of bupropion (Zyban, Wellbutrin SR, and Wellbutrin XL) should be swallowed whole, and never broken, crushed, divided, or chewed.

The dose may depend on a number of factors, including how well your liver and kidneys are functioning. Your doctor may do blood tests to check the function of these organs.

Keep the medicine in a tightly closed container and out of the reach of children or pets.

Precautions

Do not take any form of Wellbutrin along with Zyban unless you talk to your doctor; they are the same medicine.

As with other antidepressants, this drug may raise the risk of suicidal thoughts and actions, mostly in depressed people under age 25. This is more common during the first few months of treatment. If you notice any strange or unusual thoughts or behavior, such as irritability, sleep problems, aggressiveness, restlessness, panic attacks, or thoughts of suicide while on this medicine, call your doctor. Tell family members, loved ones, and caregivers that you are taking this drug, so that they can help you if they notice behavior changes that are not caused by nicotine withdrawal.

The antidepressant effects of this medicine may take 4 weeks or longer to start. Always check with your doctor before changing your dose or stopping the drug.

This drug may increase the risk of seizures. It should be used with extreme caution in people who have had seizures before. It should be taken only as prescribed. Several other drugs, including alcohol, may raise this risk if taken at the same time (see "Interactions with other drugs").

This drug may cause high blood pressure or make existing high blood pressure worse. If you are taking a drug for high blood pressure, talk to your doctor about this. Your blood pressure will be checked before and between treatments, and you may need medicine to help control it if it becomes elevated. Tell your doctor right away if notice any possible symptoms of high blood pressure, including a severe headache, chest pain, or feeling dizzy or light-headed.

In rare cases, this drug can cause allergic reactions in some people. Mild reactions usually consist of a skin rash or fever and chills. More serious reactions happen rarely, but can be dangerous. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever or chills, hives, nausea, itching, headache, coughing, shortness of breath, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms while taking this drug.

It is common to feel irritable, anxious, somewhat depressed, or have trouble sleeping when you are withdrawing from nicotine, whether or not you take bupropion. If these effects last more than a few days, check with your doctor.

Possible side effects

You will probably not have most of the following side effects .Your doctor or nurse can discuss specific care instructions with you. They can help you understand these side effects and deal with them.

Common

• restlessness (mostly when first starting the drug)
• agitation (mostly when first starting the drug)
• anxiety (mostly when first starting the drug)
• trouble sleeping (mostly when first starting the drug)

Less common

• dry mouth
• change in how things taste
• headache
• trouble concentrating
• feeling dizzy
• trembling
• rapid heart rate
• skin rash/itching
• nausea
• constipation
• diarrhea
• loss of appetite

Rare

• having to urinate often
• blurred vision
• rash with blistering
• high blood pressure*
• seizures*
• feeling paranoid*
• hallucinations
• suicidal thoughts*
• changes in behavior, including hostility and aggressiveness*
• agitation or restlessness*
• allergic reactions*

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1985.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.