Bupropion 

Uses, Side Effects, Warnings & Precautions, Interactions, and More

Bupropion, commonly known by its brand name Wellbutrin, is a medication primarily used to treat major depressive disorder and seasonal affective disorder. Additionally, it is prescribed to aid in smoking cessation under the brand name Zyban. This article provides an in-depth look at the uses, side effects, warnings, precautions, interactions, and overdose/missed dose information for this medication, ensuring you have a thorough understanding of this medication.

What is Bupropion?

Bupropion is a prescription medication classified as an atypical antidepressant. It is commonly used for:

• Treating major depressive disorder (MDD)
• Managing seasonal affective disorder (SAD)
• Helping people quit smoking

Unlike many other antidepressants, this medication does not significantly affect serotonin levels. Instead, it primarily works on dopamine and norepinephrine, neurotransmitters associated with mood, motivation, and reward mechanisms.

It is sold under various brand names, including:

• Wellbutrin SR / Wellbutrin XL – for depression and seasonal affective disorder
• Zyban – for smoking cessation

Approved Medical Uses

Major Depressive Disorder (MDD)

Bupropion is FDA-approved for treating MDD in adults. It’s often prescribed when patients don’t respond well to SSRIs or SNRIs or experience unwanted side effects like sexual dysfunction.

Seasonal Affective Disorder (SAD)

Wellbutrin XL is indicated for preventing depressive episodes in individuals with a history of SAD. It is usually started in the early fall and discontinued in spring.

Smoking Cessation (Zyban)

This medication helps reduce nicotine cravings and withdrawal symptoms. It can double a person’s chances of successfully quitting smoking when used with a behavioral support program.

Off-label Uses

Doctors may also prescribe this medication for other conditions, including:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Bipolar depression (as adjunct)
• Sexual dysfunction caused by SSRIs
• Weight management (as part of combination therapy)
• Anxiety disorders (though less common)

How Bupropion Works

Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI). It works by increasing the levels of norepinephrine and dopamine in the brain by blocking their reabsorption (reuptake) into neurons.

This boost in neurotransmitter activity:

• Enhances mood
• Increases energy and motivation
• Reduces withdrawal symptoms in nicotine addiction

Additionally, this medication has stimulant-like effects that can help improve focus and alertness, which is why it’s sometimes used off-label for ADHD.

Dosage and Administration

Bupropion is available in:

• Immediate-release (IR) – taken 3 times a day
• Sustained-release (SR) – taken 2 times a day
• Extended-release (XL) – taken once daily

Typical Dosages

Condition	Starting Dose	Maintenance Dose	Maximum Dose
MDD	150 mg daily	300 mg/day	400-450 mg/day
SAD	150 mg/day in AM	300 mg/day	300 mg/day
Smoking Cessation	150 mg/day (3 days) → 150 mg BID	150 mg BID	300 mg/day

Important Note: Always take bupro-pion at the same time daily. Swallow tablets whole—do not crush, chew, or divide, especially the extended-release form.

Common Side Effects

Like any medication, bupropion can cause side effects. However, many users tolerate it well, especially compared to other antidepressants.

Most Common Side Effects:

• Dry mouth
• Headache
• Insomnia
• Nausea
• Dizziness
• Excessive sweating
• Tremors
• Weight loss
• Agitation or anxiety (especially early on)

These side effects are often mild and temporary, improving after a few weeks of continued use.

Serious Side Effects

Though rare, bupropion can cause serious reactions in some individuals.

Seizures

This medication carries a dose-dependent risk of seizures, especially at doses over 400 mg/day. Risk factors include:

• History of seizures
• Eating disorders (e.g., anorexia nervosa, bulimia)
• Alcohol or benzodiazepine withdrawal
• Head trauma

Suicidal Thoughts

Antidepressants, including bupro-pion, may increase the risk of suicidal ideation, particularly in children, adolescents, and young adults. Monitoring is essential, especially during the first few months.

Hypertension

This medication may raise blood pressure. Monitoring is important, especially in patients with pre-existing hypertension.

Allergic Reactions

Signs of a serious allergic reaction include:

• Rash
• Itching/swelling (especially of the face/tongue)
• Severe dizziness
• Trouble breathing

Seek emergency help if any of these occur.

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Warnings and Precautions

History of Seizures

Avoid bupropion in patients with seizure disorders. Even a single past seizure increases the risk.

Eating Disorders

People with anorexia or bulimia are at a higher risk of seizures and should not take bupro-pion.

Alcohol and Drug Withdrawal

Avoid use during alcohol or sedative withdrawal as it increases seizure risk.

Bipolar Disorder

This medication can trigger manic episodes in people with undiagnosed or untreated bipolar disorder.

Liver or Kidney Disease

Reduced liver or kidney function can increase drug levels in the body, leading to toxicity.

Pregnancy and Breastfeeding

Bupro-pion is classified as Category C for pregnancy. Use only if benefits outweigh the risks. It is present in breast milk, so consult a healthcare provider before use while breastfeeding.

Driving and Operating Machinery

Until you know how bupro-pion affects you, avoid driving or operating heavy machinery.

Drug Interactions

Bupropion may interact with several other medications and substances. Key examples include:

Monoamine Oxidase Inhibitors (MAOIs)

Do not use bupropion within 14 days of taking MAOIs like phenelzine or selegiline. This combination can lead to serious side effects like hypertensive crisis.

Other Drugs that Lower Seizure Threshold

• Antipsychotics (e.g., clozapine)
• Antidepressants (e.g., SSRIs at high doses)
• Tramadol
• Theophylline
• Systemic steroids

Alcohol

Heavy alcohol use or sudden cessation increases seizure risk.

Drugs Metabolized by CYP2B6

Bupropion is metabolized by CYP2B6. Drugs that induce or inhibit this enzyme can alter its effectiveness.

NRT (Nicotine Replacement Therapy)

Combining bupropion with NRT patches increases the risk of hypertension.

Always inform your healthcare provider of all medications, supplements, and herbal products you are using.

Overdose and Missed Dose

Overdose

Symptoms of bupropion overdose may include:

• Seizures
• Hallucinations
• Confusion
• Vomiting
• Rapid heartbeat
• Loss of consciousness

Immediate medical attention is crucial. There is no specific antidote, so treatment is supportive.

Missed Dose

If you miss a dose:

• Take it as soon as you remember.
• If it’s close to the next dose, skip the missed one.
• Never double your dose to make up for a missed pill.

Maintaining a regular dosing schedule minimizes the risk of side effects and improves treatment effectiveness.

Special Populations

Children and Adolescents

Bupropion is not approved for use in children for depression. It carries a higher risk of suicidal thoughts in this population.

Elderly

Older adults may be more sensitive to side effects. Dosage adjustment and monitoring may be necessary.

People with Mental Illness

Patients with bipolar disorder or psychosis should be monitored closely, as this medication can worsen symptoms.

Tips for Safe and Effective Use

• Take bupropion exactly as prescribed—do not exceed the dose.
• Do not stop suddenly. Always taper under medical supervision.
• Avoid alcohol or drugs that increase seizure risk.
• Monitor mood changes, especially in the first few weeks.
• Take the medicine in the morning if insomnia is a concern.
• Report any unusual symptoms to your healthcare provider.

Conclusion

Bupropion is a versatile medication that offers significant benefits for individuals struggling with depression, seasonal affective disorder, and smoking cessation. However, like all medications, it comes with potential side effects and interactions that need to be carefully managed. By understanding the uses, side effects, warnings, and precautions associated with this medication, patients can work closely with their healthcare providers to maximize its benefits while minimizing risks. Always consult with a healthcare professional before starting or stopping any medication.

Frequently Asked Questions (FAQs) About Bupropion