Wellbutrin (generic: bupropion) is a prescription medication used to treat depression. Wellbutrin belongs to a group of drugs called antidepressants which work by affecting certain natural chemicals in the brain.
This medication comes in tablet form and is usually taken 3 times daily. The sustained-release tablet, Wellbutrin SR, is usually taken twice daily. The extended-release tablet, Wellbutrin XR, is usually taken once daily, in the morning.
Common side effects of Wellbutrin include difficulty sleeping and nausea.
Wellbutrin is a prescription medicine used to treat adults with a certain type of depression called major depressive disorder.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Wellbutrin can cause serious side effects (see "Black Box Warning" and "Drug Precautions").
The most common side effects of Wellbutrin are:
- trouble sleeping
- dry mouth
- and shakiness (tremor)
If you have nausea, take your medicine with food.
If you have trouble sleeping, do not take your medicine too close to bedtime.
Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:
- MAO inhibitors (isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate))
- amantadine (Symmetrel);
- beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal);
- cyclophosphamide (Cytoxan, Neosar);
- diet pills;
- insulin or oral medications for diabetes;
- medications for irregular heartbeat such as flecainide (Tambocor) and propafenone (Rythmol);
- medications for mental illness such as haloperidol (Haldol), risperidone (Risperdal), and thioridazine (Mellaril);
- medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin);
- levodopa (Sinemet, Larodopa);
- nicotine patch;
- oral steroids such as dexamethasone (Decadron, Dexone),
- methylprednisolone (Medrol), and prednisone (Deltasone);
- orphenadrine (Norflex);
- other antidepressants such as desipramine (Norpramin), fluoxetine (Prozac), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil) and sertraline (Zoloft);
- sleeping pills;
- theophylline (Theobid, Theo-Dur, others)
This is not a complete list of all drug interactions of Wellbutrin. Ask your doctor for more information.
Do not take Wellbutrin if you:
- have or had a seizure disorder or epilepsy.
- are taking Zyban (used to help people stop smoking) or any other medicines that contain bupropion hydrochloride, such as Wellbutrin SR Sustained-Release Tablets or Wellbutrin XL Extended-Release Tablets. Bupropion is the same active ingredient that is in Wellbutrin.
- drink a lot of alcohol and abruptly stop drinking, or use medicines called sedatives (these make you sleepy) or benzodiazepines and you stop using them all of a sudden.
- have taken within the last 14 days medicine for depression called a monoamine oxidase inhibitor (MAOI), such as Nardil (phenelzine sulfate), Parnate (tranylcypromine sulfate), or Marplan (isocarboxazid).
- have or had an eating disorder such as anorexia nervosa or bulimia.
- are allergic to the active ingredient in Wellbutrin, bupropion, or to any of the inactive ingredients.
Do not drink a lot of alcohol while taking Wellbutrin. If you usually drink a lot of alcohol, talk with your doctor before suddenly stopping. If you suddenly stop drinking alcohol, you may increase your risk of having seizures.
Do not drive a car or use heavy machinery until you know how Wellbutrin affects you. Wellbutrin can impair your ability to perform these tasks.
Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Wellbutrin there are no specific foods that you must exclude from your diet when receiving Wellbutrin.
Tell your doctor if you have ever had depression, suicidal thoughts or actions, or other mental health problems.
Tell your doctor about your other medical conditions including if you:
- are pregnant or plan to become pregnant. It is not known if Wellbutrin can harm your unborn baby.
- are breastfeeding. Wellbutrin passes through your milk. It is not known if Wellbutrin can harm your baby.
- have liver problems, especially cirrhosis of the liver.
- have kidney problems.
- have an eating disorder, such as anorexia nervosa or bulimia.
- have had a head injury.
- have had a seizure (convulsion, fit).
- have a tumor in your nervous system (brain or spine).
- have had a heart attack, heart problems, or high blood pressure.
- are a diabetic taking insulin or other medicines to control your blood sugar.
- drink a lot of alcohol.
- abuse prescription medicines or street drugs.
Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Many medicines increase your chances of having seizures or other serious side effects if you take them while you are using Wellbutrin.
Tell your doctor if you are pregnant or plan to become pregnant. It is not known if Wellbutrin can harm your unborn baby.
Tell your doctor if you are breastfeeding or plan to breastfeed. Wellbutrin passes through your milk. It is not known if Wellbutrin can harm your baby.
- Take Wellbutrin exactly as prescribed by your doctor.
- Take Wellbutrin at the same time each day.
- Take your doses of Wellbutrin at least 6 hours apart.
- You may take Wellbutrin with or without food.
- If you miss a dose, do not take an extra tablet to make up for the dose you forgot. Wait and take your next tablet at the regular time. This is very important. Too much Wellbutrin can increase your chance of having a seizure.
- If you take too much Wellbutrin, or overdose, call your local emergency room or poison control center right away.
- Do not take any other medicines while using Wellbutrin unless your doctor has told you it is okay.
- It may take several weeks for you to feel that Wellbutrin is working. Once you feel better, it is important to keep taking Wellbutrin exactly as directed by your doctor. Call your doctor if you do not feel Wellbutrin is working for you.
- Do not change your dose or stop taking Wellbutrin without talking with your doctor first.
Take Wellbutrin exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. Your doctor will determine the best dose for you.
The usual adult dose is 300 mg/day, given 3 times daily. Dosing should begin at 200 mg/day, given as 100 mg twice daily. Based on clinical response, this dose may be increased to 300 mg/day, given as 100 mg 3 times daily, no sooner than 3 days after beginning therapy.
Increasing the Dosage Above 300 mg/Day
As with other antidepressants, the full antidepressant effect of Wellbutrin may not be evident until 4 weeks of treatment or longer. An increase in dosage, up to a maximum of 450 mg/day, given in divided doses of not more than 150 mg each, may be considered for patients in whom no clinical improvement is noted after several weeks of treatment at 300 mg/day. Dosing above 300 mg/day may be accomplished using the 75- or 100-mg tablets. The 100-mg tablet must be administered 4 times daily with at least 4 hours between successive doses, in order not to exceed the limit of 150 mg in a single dose. Wellbutrin should be discontinued in patients who do not demonstrate an adequate response after an appropriate period of treatment at 450 mg/day.
The lowest dose that maintains remission is recommended. Although it is not known how long the patient should remain on Wellbutrin, it is generally recognized that acute episodes of depression require several months or longer of antidepressant drug treatment.
If you take too much Wellbutrin, call your local Poison Control Center or seek emergency medical attention right away.
Wellbutrin tablets are available in 75 mg and 100 mg strengths.
- 75-mg tablet − D&C Yellow No. 10 Lake, FD&C Yellow No. 6 Lake, hydroxypropyl cellulose, hypromellose, microcrystalline cellulose, polyethylene glycol, talc, and titanium dioxide;
- 100-mg tablet − FD&C Red No. 40 Lake, FD&C Yellow No. 6 Lake, hydroxypropyl cellulose, hypromellose, microcrystalline cellulose, polyethylene glycol, talc, and titanium dioxide.
- Store Wellbutrin at room temperature.
- Store out of direct sunlight.
- Keep Wellbutrin in its tightly closed bottle.
Suicidality and Antidepressant Drugs
Use in Treating Psychiatric Disorders:
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of Wellbutrin or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.
Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Wellbutrin is not approved for use in pediatric patients.
Use in Smoking Cessation Treatment:
Wellbutrin, Wellbutrin SR, and Wellbutrin XL are not approved for smoking cessation treatment, but bupropion under the name Zyban is approved for this use. Serious neuropsychiatric events, including but not limited to depression, suicidal ideation, suicide attempt, and completed suicide have been reported in patients taking bupropion for smoking cessation. Some cases may have been complicated by the symptoms of nicotine withdrawal in patients who stopped smoking. Depressed mood may be a symptom of nicotine withdrawal. Depression, rarely including suicidal ideation, has been reported in smokers undergoing a smoking cessation attempt without medication. However, some of these symptoms have occurred in patients taking bupropion who continued to smoke.
All patients being treated with bupropion for smoking cessation treatment should be observed for neuropsychiatric symptoms including changes in behavior, hostility, agitation, depressed mood, and suicide-related events, including ideation, behavior, and attempted suicide. These symptoms, as well as worsening of pre-existing psychiatric illness and completed suicide have been reported in some patients attempting to quit smoking while taking Zyban in the postmarketing experience. When symptoms were reported, most were during treatment with Zyban, but some were following discontinuation of treatment with Zyban. These events have occurred in patients with and without pre-existing psychiatric disease; some have experienced worsening of their psychiatric illnesses. Patients with serious psychiatric illness such as schizophrenia, bipolar disorder, and major depressive disorder did not participate in the premarketing studies of Zyban.
Advise patients and caregivers that the patient using bupropion for smoking cessation should stop taking bupropion and contact a healthcare provider immediately if agitation, hostility, depressed mood, or changes in thinking or behavior that are not typical for the patient are observed, or if the patient develops suicidal ideation or suicidal behavior. In many postmarketing cases, resolution of symptoms after discontinuation of Zyban was reported, although in some cases the symptoms persisted; therefore, ongoing monitoring and supportive care should be provided until symptoms resolve.
The risks of using bupropion for smoking cessation should be weighed against the benefits of its use. Zyban has been demonstrated to increase the likelihood of abstinence from smoking for as long as 6 months compared to treatment with placebo. The health benefits of quitting smoking are immediate and substantial.