What is bupropion?

Bupropion is an antidepressant that is prescribed to treat major depressive disorder (MDD) and seasonal affective disorder. It can also be used to treat smoking cessation, however, the two are not recommended to be treated together. Bupropion comes as an immediate-release, sustained-release, and extended-release tablet. The sustained and extended-release tablets dissolve slowly in your body over the course of a day and do not need to be taken as often as the immediate-release tablets.

How does bupropion work?

Similar to most mental health drugs, it is difficult to pinpoint exactly how bupropion works. However, it is believed that bupropion changes certain naturally-occurring chemicals in the brain, including dopamine and norepinephrine, to relieve the effects of MDD or seasonal affective disorder.

What doses of bupropion are available?

Bupropion extended-release tablets come in 150mg and 300mg. For both seasonal affective disorder and MDD, the usual starting dose of bupropion is 150mg, once daily. After day four, the dose usually increases to 300mg, once daily. That is considered the target dose. The gradual increase is usually to avoid possible side effects, including seizures. Often, your doctor will reassess your dosage depending on your reactions or overall medical condition.

If you are taking the sustained-release tablets for depression, your starting dose will be 150 mg by mouth once in the morning. After 3 days, your dose may be increased to 150 mg twice a day with at least 8 hours between doses. The maximum dose is 400 mg per day.

If you are taking the immediate-release tablets for depression, your starting dose will typically be 100 mg twice a day. After 3 days, your dose may be increased to 100 mg three times a day with at least 6 hours between doses. The maximum dose is 450 mg per day.

How do you use bupropion?

Be sure you take bupropion exactly how your doctor prescribes, and read the medication guide and prescribing information before starting this medication. Swallow the tablets whole. Do not cut, chew, or crush the tablets. It can be taken with or without food. If you miss a dose, do not take an extra dose of bupropion. It is important to wait and take the missed dose at your normal time, or you may increase your chances of having a seizure. If you overdose or take too much bupropion, call your closest poison control or emergency room right away for medical advice.

You may notice something that looks like a tablet in your stool. This is normal. Some dosage forms of bupropion contain a non-absorbable shell that has been specially designed to slowly release the drug in your body.

It may take several weeks for you to feel the effects of bupropion after starting it. However, you can call your doctor if you do not believe it is working for you. If you are using it for seasonal affective disorder, make sure you take it through the autumn-winter seasons and exactly how your doctor prescribes. Do not stop taking bupropion without your doctor’s advice, even if your symptoms subside.

Especially at the beginning, be sure to monitor for changes in your mood, behavior, or thinking patterns. If your depression worsens or if you have suicidal thoughts, call your doctor immediately.

What are the side effects of bupropion?

The most common side effects of bupropion in clinical trials compared to placebo include:

Weight loss
Dry mouth
Loss of appetite
Rash
Feeling anxious
Sweating
Trouble sleeping
Dizziness
Joint aches
Constipation and gas
Nausea

Rarely, bupropion may cause some serious side effects, including:

New or worse mental health problems, including:
- Overall unusual changes in behavior or thinking, aggression, depressed mood, hostility, suicidal thoughts or actions, panic attacks, and agitation.
- Call your doctor right away if you experience any of these symptoms.
Severe high blood pressure
Manic episodes, with symptoms including:
- Racing thoughts
- Excessive happiness or irritability
- Overactivity
Seizures.
- Discontinue bupropion if seizures occur.
Eye problems, including eye pain, swelling, or seeing halos of light.
Severe allergic reactions, with symptoms that could include:
- Hives
- Fever
- Swollen lymph glands
- Trouble breathing

Contact your healthcare professional for medical advice about any possible adverse effects you experience while taking bupropion. You can report your adverse effects to the Food and Drug Administration at 1-800-FDA-1088 or www.fda.gov/medwatch.

Bupropion drug interactions

When bupropion is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Some drug interactions with bupropion include:

Drugs that lower your resistance to seizures.
- Be sure you speak to your doctor about all medications you take as certain medications can increase your risk of seizures with bupropion.
CYP2B6 inducers.
- You may need to increase your dose of bupropion if you take CYP2B6 inducers (ritonavir, efavirenz, carbamazepine).
- Do not exceed the maximum recommended dose.
Any drug that is metabolized by CYP2D6. Taking bupropion with CYP2D6 drugs can increase concentrations of:
- Antidepressants (paroxetine, fluoxetine, sertraline).
- Antipsychotics (haloperidol, thioridazine).
- Beta-blockers and Type 1C antiarrhythmics.
- Tamoxifen.
Dopaminergic drugs.
- Central nervous system (CNS) toxicity is a possibility.
Monoamine oxidase inhibitors (MAOIs).
- Do not use MAOIs and bupropion at the same time or within 14 days of each other.
Drug-laboratory test interactions.
- Bupropion can cause false positive urine test results for amphetamines.
Any other medication that also contains bupropion as it can increase the risk of overdose. This includes:
- Wellbutrin SR, Aplenzin, Zyban, or Forfivo XL.

Boxed warnings

There is an increased risk of suicidal behavior and thinking in adolescents, children, and young adults taking bupropion as an antidepressant. Continued monitoring for new or worsening suicidal thoughts and behaviors is important.

Bupropion precautions

You should be sure that your healthcare provider is aware of all your medical conditions, including if you have a history of:

A seizure disorder.
- You should not take bupropion if you have a seizure disorder or are currently on medication to treat your seizures.
A prior or current diagnosis of anorexia or bulimia.
- You should not take bupropion if you currently are struggling with, or have a serious history with, an eating disorder.
Pregnancy, plan on becoming pregnant or are breastfeeding.
- It is unknown whether bupropion will harm a fetus. Speak to your doctor for the right treatment for you.
Using an MAOI medication (linezolid, tranylcypromine, phenelzine, selegiline) within 14 days before or after starting bupropion.
Drink alcohol, use street drugs or sedatives such as benzodiazepines or barbiturates.
Have a known allergic reaction to bupropion or any of the inactive ingredients of the product’s formulation.
Personal or family history of glaucoma, as it may cause angle-closure glaucoma
High blood pressure, heart attack, or heart disease.
Diabetes.
Bipolar disorder or history of other mental illnesses.
Are taking Zyban to help you stop smoking or other medicines that contain bupropion hydrochloride.
A head injury.

Is there a generic available for bupropion?

Bupropion is the generic drug for the brand names: Wellbutrin XL, Forfivo XL, Aplenzin, Wellbutrin SR, Zyban, and Budeprion XL.

How do you store bupropion?

Keep bupropion at room temperature and out of the reach of children. Keep it in its tightly closed container and out of direct sunlight. The tablets may have an odor.