Bupropion

WHY is this medicine prescribed?

Bupropion (Aplenzin, Wellbutrin, Wellbutrin SR, Wellbutrin XL) is used to treat depression. Bupropion (Aplenzin, Wellbutrin XL) is also used to treat seasonal affective disorder (SAD; episodes of depression that occur at the same time each year [usually in the fall and winter but rarely may occur in the spring or summer months]). Bupropion (Zyban) is used to help people stop smoking. Bupropion is in a class of medications called antidepressants. It works by increasing certain types of activity in the brain.

HOW should this medicine be used?

Bupropion comes as a tablet and a sustained-release or extended-release (long-acting) tablet to take by mouth. The regular tablet (Wellbutrin) is usually taken three times a day, with doses at least 6 hours apart, or four times a day, with doses at least 4 hours apart. The sustained-release tablet (Wellbutrin SR, Zyban) is usually taken twice a day, with doses at least 8 hours apart. The extended-release tablet (Aplenzin, Wellbutrin XL) is usually taken once daily in the morning; doses of the extended-release tablet should be taken at least 24 hours apart. When bupropion is used to treat seasonal affective disorder, it is usually taken once a day in the morning beginning in the early fall, continuing through the winter, and stopping in the early spring. Sometimes a lower dose of bupropion is taken for 2 weeks before the medication is stopped. Take bupropion with food if the medication upsets your stomach. If you have trouble falling asleep or staying asleep, do not take bupropion too close to bedtime. Take bupropion at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take bupropion exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the sustained-release and extended-release tablets whole; do not split, chew, or crush them.

Your doctor will probably start you on a low dose of bupropion and gradually increase your dose.

It may take 4 weeks or longer before you feel the full benefit of bupropion. Continue to take bupropion even if you feel well. Do not stop taking bupropion without talking to your doctor. Your doctor may decrease your dose gradually.

Are there OTHER USES for this medicine?

Bupropion is also sometimes used to treat episodes of depression in patients with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods) and to treat attention deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age). Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What SPECIAL PRECAUTIONS should I follow?

Before taking bupropion,

• tell your doctor and pharmacist if you are allergic to bupropion, any other medications, or any of the ingredients in bupropion tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate).
• do not take more than one product containing bupropion at a time. You could receive too much medication and experience severe side effects.
• some medications should not be taken with bupropion. Other medications may cause dosing changes or extra monitoring when taken with bupropion. Make sure you have discussed any medications you are currently taking or plan to take before starting bupropion with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking bupropion, please get the advice of your doctor or pharmacist.
• the following nonprescription product may interact with bupropion: cimetidine (Tagamet). Be sure to let your doctor and pharmacist know that you are taking this medication before you start taking bupropion. Do not start this medication while taking bupropion without discussing with your healthcare provider.
• tell your doctor if you have or have ever had seizures, anorexia nervosa (an eating disorder) or bulimia (an eating disorder). Also tell your doctor if you drink large amounts of alcohol but expect to suddenly stop drinking or you take sedatives but expect to suddenly stop taking them. Your doctor will probably tell you not to take bupropion.
• tell your doctor if you drink large amounts of alcohol, use street drugs, or overuse prescription medications and if you have ever had a heart attack; a head injury; a tumor in your brain or spine; high blood pressure; diabetes; or liver, kidney, or heart disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking bupropion, call your doctor.
• you should know that bupropion may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• talk to your doctor about the safe use of alcoholic beverages while you are taking bupropion. Alcohol can make the side effects from bupropion worse.
• you should know that bupropion may cause an increase in your blood pressure. Your doctor may check your blood pressure before starting treatment and regularly while you are taking this medication, especially if you also are using nicotine replacement therapy.
• you should know that bupropion may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.
• you should know that some people have reported symptoms such as changes in behavior, hostility, agitation, depressed mood, and suicidal thoughts (thinking about harming or killing oneself or planning or trying to do so) while taking bupropion to stop smoking. The role of bupropion in causing these mood changes is unclear since people who quit smoking with or without medication may experience changes in their mental health due to nicotine withdrawal. However, some of these symptoms occurred in people who were taking bupropion and continued to smoke. Some people had these symptoms when they began taking bupropion, and others developed them after several weeks of treatment or after stopping bupropion. These symptoms have occurred in people without a history of mental illness and have worsened in people who already had a mental illness. Tell your doctor if you have or have ever had depression, bipolar disorder (mood that changes from depressed to abnormally excited), schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), or other mental illnesses. If you experience any of the following symptoms, stop taking bupropion (Zyban) and call your doctor immediately: suicidal thoughts or actions; new or worsening depression, anxiety, or panic attacks; agitation; restlessness; angry or violent behavior; acting dangerously; mania (frenzied, abnormally excited or irritated mood); abnormal thoughts or sensations; hallucinations (seeing things or hearing voices that do not exist); feeling that people are against you; feeling confused; or any other sudden or unusual changes in behavior. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own. Your doctor will monitor you closely until your symptoms get better.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Skip the missed dose and continue your regular dosing schedule. Always allow the full scheduled amount of time to pass between doses of bupropion. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Bupropion may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• drowsiness
• anxiety
• excitement
• difficulty falling asleep or staying asleep
• dry mouth
• dizziness
• headache
• nausea
• vomiting
• stomach pain
• uncontrollable shaking of a part of the body
• loss of appetite
• weight loss
• constipation
• excessive sweating
• ringing in the ears
• changes in your sense of taste
• frequent urination
• sore throat

If you experience any of the following symptoms, stop taking bupropion and call your doctor immediately or get emergency medical treatment:

• fever
• rash or blisters
• itching
• hives
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• difficulty breathing or swallowing
• chest pain

Bupropion may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• seizure
• hallucinating (seeing things or hearing voices that do not exist)
• loss of consciousness
• rapid or pounding heartbeat

What OTHER INFORMATION should I know?

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking bupropion.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

If you are taking the extended-release tablet, you may notice something that looks like a tablet in your stool. This is just the empty tablet shell and does not mean that you did not get your complete dose of medication.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: February 15, 2018.