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Wellbutrin: 7 things you should know

March 2020 Comment 1K Report

Wellbutrin: 7 things you should know

Wellbutrin: 7 things you should know

Written by Carmen Fookes, BPharm on Mar 17, 2020

1. How it works
  • Wellbutrin is an antidepressant that may be used to treat Major Depressive Disorder (MDD) and Seasonal Affective Disorder (SAD). Wellbutrin is a brand name for bupropion.
  • Experts aren't exactly sure how bupropion works in depression but presume it is due to its ability to inhibit the reuptake of two neurotransmitters, norepinephrine, and dopamine (although this reuptake inhibition is weak). Bupropion does not affect the reuptake of serotonin or inhibit monoamine oxidase.
  • Bupropion is an aminoketone antidepressant and is chemically unrelated to any other type of antidepressant.
2. Upsides
  • Wellbutrin may be used to relieve the symptoms of depression in Major Depressive Disorder (MDD) and Seasonal Affective Disorder (SAD).
  • Generic bupropion is available and bupropion is also marketed under other brand names such as Aplenzin (also for depression) and Zyban (for smoking cessation).
3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Insomnia, headache, dizziness, dry mouth, sore throat, nausea, and constipation are the more commonly reported side effects. May also cause abdominal pain, abnormal dreams, flushing, muscle and joint pain, migraine, rash or itchy skin.
  • Severe neuropsychiatric symptoms, including agitation, anxiety, delusions, hallucinations, panic disorder, paranoia, and psychosis have been reported with Wellbutrin use and it carries a black box warning for these effects. Symptoms have occurred in people with and without pre-existing psychiatric disease. People should be monitored for the appearance of neuropsychiatric symptoms. Most cases resolved on discontinuation of Wellbutrin; however, a few persisted.
  • More likely than other antidepressants to cause weight loss; however, may also cause weight gain in some people.
  • May increase blood pressure. Blood pressure should be taken on treatment initiation and monitored periodically.
  • The dosage of Wellbutrin requires adjusting in kidney and liver disease.
  • May not be suitable for some people including those with seizure disorders; eating disorders; undergoing alcohol, anticonvulsant, barbiturate, or benzodiazepine withdrawal; at risk of glaucoma; pregnant or breastfeeding; or taking monoamine oxidase inhibitors.
  • As with other antidepressants, Wellbutrin may increase the risk of suicidal thoughts or behavior. The risk is greatest for children and young adults under the age of 24. Monitor for worsening mood.
  • May increase the risk of seizures. This risk is increased with higher dosages of Wellbutrin, in those with head injuries or taking other medications which also lower the seizure threshold.
  • May cause allergic reactions in some people with symptoms such as itchiness, facial swelling, and hives (urticaria). Stop treatment immediately and seek medical help.
  • May cause a discontinuation syndrome if abruptly stopped or interrupted (symptoms include nausea, vomiting, diarrhea, headaches, dizziness, sweating, chills, tremors, vivid dreams, and insomnia).
  • May interact with other drugs, such as other antidepressants; antipsychotics; agents that affect the electrical conductivity in the heart; those that induce or inhibit hepatic enzymes CYP2B6 or are metabolized by CYP2D6; other drugs that increase dopamine; or those that increase bleeding risk.
  • Interaction with other medicines that increase serotonin levels (such as tramadol, other antidepressants, St John's wort) or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium], fast heart rate, dizziness, flushing, muscle tremor or rigidity, and stomach symptoms [such as nausea, vomiting, diarrhea]).
  • Rare cases of priapism (painful erections more than 6 hours in duration) have been reported.
  • May cause false-positive results on urine screening tests for amphetamines.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here. 4. Bottom Line

Wellbutrin may be used in the treatment of depression; however, side effects may include insomnia, neuropsychiatric adverse events, or seizures. It carries a black box warning because it may cause changes in behavior and increase the risk of suicidal thoughts.

5. Tips
  • Can be taken with or without food.
  • Avoid taking the last dose of the day after 5pm to minimize the risk of insomnia. At least eight hours should separate twice daily dosings of Wellbutrin, and at least six hours should separate three times daily dosings of Wellbutrin. Take Wellbutrin exactly as directed by your doctor.
  • Regardless of whether Wellbutrin is being used as an antidepressant or as a smoking cessation aid, it should be started at a low dose and tapered up slowly over several days. Your doctor will advise you how to do this. Controlled-release forms of Wellbutrin should be swallowed whole. Do not crush, divide, or chew because this may increase the risk of adverse effects including seizures.
  • Zyban contains the same active ingredient as Wellbutrin, which is bupropion, and the two should never be used together.
  • Wellbutrin may affect your judgment and your ability to drive or operate machinery. Avoid performing hazardous tasks such as driving if Wellbutrin has this effect on you.
  • When used to treat Seasonal Affective Disorder (SAD), Wellbutrin should be initiated in the autumn before the onset of depressive symptoms, continued throughout the winter season, and tapered off in early spring.
  • Be alert for changes in behavior or mood including agitation, depression, or suicide-related events. Seek immediate medical advice if any changes are apparent.
  • Stop taking Wellbutrin if any symptoms suggestive of an allergic reaction occur (such as itchiness, body rash, swelling) and seek immediate medical help.
  • See your doctor immediately if you develop any eye pain, visual disturbances, or swelling or redness around the eye.
  • Do not stop Wellbutrin abruptly unless on a doctor's advice or if an allergic reaction occurs. If you need to discontinue Wellbutrin, your doctor will advise you how to do so slowly.
  • Minimize or avoid consumption of alcohol as your tolerance to it may be diminished while taking Wellbutrin, and it may also increase the risk of neuropsychiatric adverse events.
  • Talk to your doctor or pharmacist before you take any other medication with Wellbutrin, including that bought over-the-counter.
6. Response and Effectiveness
  • Improvements in sleep, energy, or appetite may be apparent within the first 1-2 weeks. Depressed mood or motivation may take up to 6-8 weeks to fully improve.
  • Bupropion is metabolized to three active metabolites once in the body, each with varying durations of action.
7. Interactions

Medicines that interact with Wellbutrin may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Wellbutrin. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Wellbutrin include:

  • antiarrhythmics, such as amiodarone or flecainide
  • anticonvulsants, such as carbamazepine, phenytoin, phenobarbital, or primidone
  • antidepressants, such as SSRIs (eg, fluoxetine, sertraline), tricyclic antidepressants (such as desipramine, nortriptyline), or MAOIs (such as phenelzine or selegiline)
  • antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
  • any medication that lowers the seizure threshold, such as tramadol, reserpine, and volatile anesthetics
  • beta-blockers, such as atenolol or metoprolol
  • blood thinners, such as clopidogrel or ticlopidine
  • corticosteroids, such as prednisone or methylprednisone
  • HIV medications, such as ritonavir or lopinavir
  • levodopa
  • theophylline.

Avoid drinking alcohol or taking illegal or recreational drugs while taking Wellbutrin.

Note that this list is not all-inclusive and includes only common medications that may interact with Wellbutrin. You should refer to the prescribing information for Wellbutrin for a complete list of interactions.

References
  • Wellbutrin (bupropion) (Package Insert). Revised 03/2019. GlaxoSmithKline LLC https:// /pro/wellbutrin.html
Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use wellbutrin only for the indication prescribed.

Copyright 1996-2020 . Revision date: March 16, 2020.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

More about Wellbutrin (bupropion)
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Consumer resources
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