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Bupropion is a drug primarily used as an antidepressant and smoking cessation aid. Marketed as Aplenzin, Budeprion, Elontril, Wellbutrin or other trade names, it is one of the most frequently prescribed antidepressants in the United States.Although in many English-speaking countries, including the United Kingdom, Australia and New Zealand, this is an off-label use. Marketed in lower-dose formulations as Prexaton, Voxra, Zyban, or other names, it is also widely used to aid people who are trying to quit smoking.It is taken in the form of tablets, and in the United States and most other countries it is available only with a prescription.
Clinically, bupropion serves as an atypical antidepressant fundamentally different from most commonly prescribed antidepressants such as selective serotonin reuptake inhibitors (SSRIs).It is an effective antidepressant on its own, but is also popular as an add-on medication in cases of incomplete response to first-line SSRI antidepressants. In contrast to many other antidepressants, it does not cause weight gain or sexual dysfunction.The most important side effect is an increase in risk for epileptic seizures, which caused the drug to be withdrawn from the market for some time and then caused the recommended dosage to be reduced.
Medical uses
Depression
Bupropion is one of the most widely prescribed antidepressants, and the available evidence indicates that it is effective in clinical depression— as effective as several other widely prescribed drugs, including fluoxetine (Prozac) and paroxetine (Paxil), although trends favoring the efficacy of escitalopram (Lexapro), sertraline (Zoloft) and venlafaxine (Effexor) over bupropion have been observed. Mirtazapine (Remeron), on the other hand is significantly more effective than bupropion.It has several features that distinguish it from other antidepressants: for instance, unlike the majority of antidepressants, bupropion does not usually cause sexual dysfunction.Bupropion treatment also is not associated with the somnolence or weight gain that may be produced by other antidepressants.
Smoking cessation
The next most common use is as an aid for smoking cessation where it reduces the severity of nicotine cravings and withdrawal symptoms.A typical bupropion treatment course lasts for seven to twelve weeks, with the patient halting the use of tobacco about ten days into the course. Bupropion approximately doubles the chance of quitting smoking successfully after three months. One year after treatment, the odds of sustaining smoking cessation are still 1.5 times higher in the bupropion group than in the placebo group.
Obesity
Bupropion when used for treating obesity over a period of 6 to 12 months, may result in weight loss of 2.7 kg over placebo. This is not much different from the weight loss produced by several other established medications, such as sibutramine, orlistat and amfepramone.
It has been studied in combination with naltrexone.Concerns from bupropion include an increase in blood pressure and heart rate and thus as of 2013 it has not been approved in the United States for this use
Sexual dysfunction
Bupropion is one of few antidepressants that does not cause sexual dysfunction.A range of studies demonstrate that bupropion not only produces fewer sexual side effects than other antidepressants, but can actually help to alleviate sexual dysfunction.
Bupropion is an antidepressant used to treat a variety of conditions, including depression, other mental/mood disorders, and smoking cessation. Antidepressants can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience new or worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication, even if treatment is not for a mental/mood condition.
Tell the doctor immediately if you notice new or worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
If you are using bupropion to quit smoking, stop taking bupropion and contact your doctor immediately if you experience any of the symptoms listed above. Tell your doctor right away if you have any of these symptoms after stopping treatment.
Bupropion is used to treat depression. It can improve your mood and feelings of well-being. It may work by helping to restore the balance of certain natural chemicals (neurotransmitters) in your brain.
OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.
Bupropion may also be used to treat attention deficit hyperactivity disorder (ADHD), or to help people quit smoking by decreasing cravings and nicotine withdrawal effects. It may be used to prevent autumn-winter seasonal depression (seasonal affective disorder). This drug may also be used with other medications to treat bipolar disorder (depressive phase).
How to use Wellbutrin
Read the Patient Information Leaflet and Medication Guide available from your pharmacist before you start using bupropion and each time you get a refill. Consult your doctor or pharmacist if you have any questions.
Take this medication by mouth, with or without food, usually three times daily. If stomach upset occurs, you may take this drug with food. It is important to take your doses at least 6 hours apart or as directed by your doctor to decrease your risk of having a seizure.
Do not take more or less medication or take it more frequently than prescribed. Taking more than the recommended dose of bupropion may increase your risk of having a seizure. Do not take more than 150 milligrams as a single dose, and do not take more than 450 milligrams per day.
Your dosage is based on your medical condition and response to therapy. Your dose may be slowly increased to limit side effects such as sleeplessness, and to decrease the risk of seizures. To avoid trouble sleeping, do not take this medication too close to bedtime. Let your doctor know if sleeplessness becomes a problem.
Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day.
Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.
It may take 4 or more weeks before you notice the full benefit of this drug. Continue to take this medication as directed by your doctor even after you feel better. Talk to your doctor if your condition does not improve or if it worsens.
Nausea, vomiting, dry mouth, headache, constipation, increased sweating, joint aches, sore throat, blurred vision, strange taste in the mouth, or dizziness may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor immediately if any of these unlikely but serious side effects occur: chest pain, fainting, fast/pounding/irregular heartbeat, hearing problems, ringing in the ears, severe headache, mental/mood changes (e.g., agitation, anxiety, confusion, hallucinations, memory loss), uncontrolled movements (tremor), unusual weight loss or gain.
Tell your doctor immediately if any of these rare but very serious side effects occur: muscle pain/tenderness/weakness, change in the amount of urine.
This drug may infrequently cause seizures. Seek immediate medical attention if you experience a seizure. If you have a seizure while taking bupropion, you should not take this drug again.
A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
Suicidal Thoughts And Behaviors In Children, Adolescents, And Young Adults
Patients with MDD, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment.
Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (selective serotonin reuptake inhibitors [SSRIs] and others) show that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18 to 24) with MDD and other psychiatric disorders. Short-term clinical trials did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond age 24; there was a reduction with antidepressants compared with placebo in adults aged 65 and older.
The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4,400 subjects.
The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.
To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.
Some products that may interact with this drug include: amantadine, certain x-ray dyes (including iomeprol), levodopa, nicotine products (such as patches, gum, or spray), regular use of sedatives (such as alprazolam), stimulants, tamoxifen, warfarin.
Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.
Other medications can affect the removal of bupropion from your body, which may affect how bupropion works. Examples include cyclophosphamide, orphenadrine, thiotepa, antiplatelet drugs (including clopidogrel, ticlodipine), anti-seizure drugs (such as carbamazepine, phenobarbital, phenytoin), HIV drugs (such as efavirenz, ritonavir), rifamycins (such as rifampin), among others.
Bupropion can speed up the removal of other drugs from your body, which may affect how they work. Examples of affected drugs include citalopram, antiarrhythmics (such as propafenone, flecainide), antidepressants (such as desipramine, paroxetine, fluoxetine, sertraline), antipsychotics (such as haloperidol, thioridazine), beta-blockers (such as metoprolol), among others.
Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with bupropion, such as antipsychotics (e.g., chlorpromazine), tricyclic antidepressants (e.g., amitriptyline), corticosteroids (e.g., prednisone) or theophylline, among others. Consult your doctor or pharmacist for details.
Large amounts of caffeine and other stimulants, such as those found in weight loss and cold/sinus medications, can increase the chance of seizures with this drug. Check all nonprescription/prescription/herbal drug labels for caffeine and other stimulants (e.g., ephedra). Consult your doctor or pharmacist.
This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson's disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.
If overdose is suspected, contact a poison control center or emergency room immediately.Symptoms of overdose may include: seizures, hallucinations, fast or slow heart rate, loss of consciousness.
Notes
Do not share this medication with others.
Psychiatric/medical checkups or tests such as blood pressure monitoring may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more
Missed Dose
If you miss a dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Storage
Store at room temperature between 59-77 degrees F (15-25 degrees C) away from light and moisture. Bupropion tablets may have a strange odor. This is normal and the medication is still okay to use. Do not store in the bathroom. Keep all medicines away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised March 2014. Copyright(c) 2014 First Databank, Inc.
