Bupropion

DEA Class;  Rx

Common Brand Names; Budeprion SR, Aplenzin, Buproban, Wellbutrin SR, Wellbutrin XL, Forfivo XL, Zyban (DSC)

Hypersensitivity to bupropion or other ingredients

History of anorexia/bulimia; patients undergoing abrupt discontinuation of ethanol or sedatives including anticonvulsants, barbiturates, or benzodiazepines

Coadministration of any other medications that contain bupropion, because seizures are dose dependent

• Headache (25-34%)
• Dry mouth (17-28%)
• Nausea (1-18%)
• Weight loss (15-20%)
• Insomnia (11-20%)
• Agitation (2-32%)
• Dizziness (6-22%)
• Pharyngitis (3-13%)
• Constipation (5-10%)
• Infection (8-9%)
• Abdominal pain (2-9%)
• Anxiety (5-7%)
• Diarrhea (5-7%)
• Tinnitus (3-6%)
• Tremor (3-6%)
• Nervousness (3-5%)
• Anorexia (3-5%)
• Palpitation (2-6%)
• Myalgia (2-6%)
• Sweating (2-5%)
• Rash (1-5%)
• Sinusitis (1-5%)
• Weight gain (4%)
• Chest pain (3-4%)
• Urinary frequency (2%)
• Vaginal hemorrhage (2%)
• Pruritus (2-4%)
• Vomiting (2-4%)
• Arthralgia (1-4%)
• Flushing (1-4%)
• Migraine (1-4%)
• Decreased memory (<3%)
• Irritability (2-3%)
• Somnolence (2-3%)
• Dysphagia (<2%)
• Arthritis (2%)

Caution in severe hepatic cirrhosis (do not exceed 150 mg every other day), mild-moderate hepatic impairment, head trauma and prior seizure history, CNS tumor, concomitant meds lowering seizure threshold

Observe patients for neuropsychiatric symptoms, such as changes in behavior, hostility, agitation, depressed mood, and suicide-related events, including ideation, behavior, and attempted suicide (see Black Box Warnings); therapy may cause delusions, hallucinations, psychosis, paranoia, confusion, and concentration disturbance; symptoms may abate with dose reduction

Healthcare provider should evaluate severity of adverse events and extent to which patient is benefiting from treatment, and consider options including continued treatment under closer monitoring, or discontinuing treatment; in many postmarketing cases, resolution of symptoms after discontinuation of bupropion reported; however, symptoms persisted in some cases; ongoing monitoring and supportive care should be provided until symptoms resolve

Potential risk of hepatotoxicity

Assess blood pressure before initiating treatment with sustained release formulation, and monitor periodically during treatment; risk of hypertension is increased if sustained release formulation is used concomitantly with MAOIs or other drugs that increase dopaminergic or noradrenergic activity; use caution in patients with cardiovascular disease

May cause weight loss; use caution if weight loss not desirable

May cause CNS depression and impair ability to operate heavy machinery

Extended-release: Do not administer less than 8 hr apart

Seizure risk is dose-related; can minimize risk by limiting daily dose to 522 mg and gradually increasing dose; discontinue permanently in patients who experience seizures

May cause sexual dysfunction

There is an independent pregnancy exposure registry that monitors pregnancy outcomes in women exposed to any antidepressants during pregnancy

Data from published literature report presence of drug and its metabolites in human milk