BUPROPION (Wellbutrin, Zyban)
Bupropion HCl is indicated for the treatment of depression and as a smoking
cessation treatment.
Side Effects
Bupropion has numerous side effects on all the body systems
*Body as a Whole: Headache, Infection, Abdominal pain, Flu-like symptoms
*Dermatologic: Rash, Sweating, Pruritis
*Cardiovascular: Palpitation, Flushing, Edema
*Gastrointestinal: Nausea, Dry Mouth, Decreased Appetite, Vomiting, diarrhea,
Abdominal Pain, Constipation
*Nervous System: Insomnia, Agitation, Anxiety, Nervousness, Irritability,
Ataxia (lack of muscle coordination), Seizure, Myoclonus (muscle spasm),
Dyskinesia (impairment of voluntary movement), Dystonia (disorder of muscle
tone) Somnolence (sleepiness), Tremor, Dizziness
*Psychiatric: Mania/hypomania, Increased libido, Hallucinations, decrease
in sexual function and depression
*Respiratory: Pharyngitis
*Urogenital: Urinary frequency, Nocturia
*Special Senses: Tinnitus, Taste perversion
Precautions and drug interactions:
Bupropion has adverse interactions with many drugs. Bupropion should not
be taken with the following medications:
*Nicotine: Using bupropion HCl and nicotine patches together may raise your
blood pressure.
*MAOI'S
*Other Antidepressants
*Alcohol: Alcohol and bupropion can lead to seizures
*Levodopa
Other precautions
*Suicide: The possibility of a suicide attempt is inherent in depression
and may persist until significant remission occurs.
*Allergic Reactions: Allergic reactions characterized by symptoms such as
pruritis, urticaria, angioedema, and dyspnea, requiring medical treatment
have been reported for bupropion HCl for smoking cessation.
*Be aware that Zyban, used as an aid to smoking cessation, contains the
same active ingredient found in Wellbutrin and Wellbutrin SR used to treat
depression and that Zyban should not be used in conjunction with Wellbutrin,
Wellbutrin SR, or any other medications that contain bupropion HCl.
*DO NOT SMOKE AT ANY TIME: It is possible to get too much nicotine and have
serious side effects.
IMPORTANT WARNING: At a dose of 300 mg each day, there is a chance that
approximately 1 out of every 1000 people taking bupropion HCl, the active
ingredient in bupropion sustained release tablets, will have a seizure.
The chance of this happening increases if you:
*Have a seizure disorder (for example, epilepsy).
*Have or have had an eating disorder (for example, bulimia or anorexia nervosa).
*Take more than the recommended amount of bupropion sustained release tablets.
*Take other medications with the same active ingredient that is in bupropion
HCl (such as taking Wellbutrin (bupropion HCl for depression) and taking
Zyban (bupropion HCl for smoking cessation).
You can reduce the chance of experiencing a seizure by following your doctor's
directions on how to take bupropion HCl. You should also discuss with your
doctor whether bupropion HCl is right for you.
Pregnancy and Nursing Mothers
Bupropion is in pregnancy category B. this drug should be used during pregnancy
only if clearly needed. Pregnant smokers should be encouraged to attempt
cessation using educational and behavioral interventions before pharmacological
approaches are used.
Like many other drugs, bupropion and its metabolites are secreted in human
milk. Because of the potential for serious adverse reactions in nursing
infants from bupropion, a decision should be made whether to discontinue
nursing or to discontinue the drug, taking into account the importance of
the drug to the mother.
Pediatric Use
Clinical trials with bupropion HCl for smoking cessation did not include
individuals under the age of 18. Therefore, the safety and efficacy in a
pediatric smoking population have not been established. The immediate release
formulation of bupropion was studied in 104 pediatric patients (age range,
6 to 16) in clinical trials of the drug for other indications. Although
generally well tolerated, the limited exposure is insufficient to assess
the safety of bupropion in pediatric patients.
Geriatric Use
No overall differences in safety or effectiveness were observed between
these subjects and younger subjects, and other reported clinical experience
has not identified differences in responses between the elderly and younger
patients, but greater sensitivity of some older individuals cannot be ruled
out. Bupropion HCl and its metabolites are almost completely excreted through
the kidney and metabolites are likely to undergo conjugation in the liver
prior to urinary excretion. The risk of toxic reaction to this drug may
be greater in patients with impaired renal function. Because elderly patients
are more likely to have decreased renal function, care should be taken in
dose selection, and it may be useful to monitor renal function
Drug Abuse and Dependence
Bupropion is not a controlled substance. Controlled clinical studies of
bupropion conducted in normal volunteers, in subjects with a history of
multiple drug abuse, and in depressed patients showed some increase in motor
activity and agitation/excitement. There have been few reported cases of
drug dependence and withdrawal symptoms associated with the immediate release
form of bupropion.
Recommended Dosage
Recommended dosage differs depending upon the condition being treated.
*Treatment of Depression: Sustained Release: The usual adult target dose
for bupropion sustained release tablets is 300 mg/day, given as 150 mg,
twice daily. Dosing with bupropion sustained release tablets should begin
at 150 mg/day given as a single daily dose in the morning
* Treatment of Depression: Immediate Release: Increases in dose should not
exceed 100 mg/day in a 3-day period. No single dose of bupropion HCl should
exceed 150 mg. Bupropion HCl should be administered three times daily, preferably
with at least 6 hours between successive doses. The usual adult dose is
300 mg/day, given three times daily.
* Treatment for Smoking Cessation: The recommended and maximum dose of bupropion
HCl sustained release tablets for smoking cessation is 300 mg/day, given
as 150 mg twice daily. Dosing should begin at 150 mg/day given every day
for the first 3 days, followed by a dose increase for most patients to the
recommended usual dose of 300 mg/day. There should be an interval of at
least 8 hours between successive doses. Doses above 300 mg/day should not
be used
Overdose
Since introduction, overdoses of up to 17,500 mg of the immediate release
formulation of bupropion have been reported. Seizure was reported in approximately
one third of all cases. Other serious reactions reported with overdoses
of the immediate release formulation of bupropion alone included hallucinations,
loss of consciousness, and sinus tachycardia (rapid heartbeat). Fever, muscle
rigidity, rhabdomyolysis (The destruction of skeletal muscle cells), hypotension
(low blood pressure), stupor, coma, and respiratory failure have been reported
when the immediate release formulation of bupropion was party of multiple
drug overdoses.
*Information for smokers
Insurance companies will not cover Zyban to stop smoking, but will cover
Wellbutrin for depression. If you are considering using bupropion to stop
smoking, speak with your doctor and see if he will work with you to prescribe
bupropion sustained release for depression.