What is bupropion, or Wellbutrin?
Other names include Aplenzin, Budeprion, Forfivo, Chantix, and Zyban.
This article will look at how Wellbutrin is used, how it works, its side effects, and any important warnings.
- Wellbutrin is an antidepressant and it can help people stop smoking.
- Some studies show that Wellbutrin might be useful in treating methamphetamine dependence.
- It does not usually lead to weight gain or sexual dysfunction.
- Side effects can include dizziness, rashes, and confusion and seizures in those who are prone to them.
What is Wellbutrin?
Bupropion, or Wellbutrin, is a commonly used antidepressant.
Wellbutrin is classed as an aminoketone.
It was first approved for clinical use in the United States (U.S.) in 1985. It is one of the most frequently prescribed antidepressants in the English-speaking world.
It is mainly used to treat and prevent depression and as a smoking cessation aid.
It is less likely to cause weight gain or sexual dysfunction than an SSRI, but it can trigger seizures in those who are susceptible.
Most antidepressants are selective serotonin reuptake inhibitor (SSRI). They boost the levels of serotonin in the brain.
Bupropion, or Wellbutrin, is different. It is a norepinephrine-dopamine reuptake inhibitor (NDRI).
An NDRI boosts levels of the neurotransmitters norepinephrine, also known as noradrenaline, and dopamine.
Its action is complex, and its neurological effects are only partly understood.
As well as being an antidepressant, bupropion is an antagonist at nicotinic receptors. This means that it blocks receptors where nicotine normally binds, making it useful in smoking cessation.
Wellbutrin is taken by mouth as a 75-milligram (mg) tablet, a 100-mg tablet, or a 150-mg extended release (XR) tablet. The 150-mg XR tablet is more popular.
A person who is using the 150-mg SR tablet will take one tablet twice a day. No single dose should exceed 150 mg, and the daily dose should not exceed 450 mg.
The tablet should be taken in the morning and, in the case of the XR tablet, swallowed whole. Breaking or chewing an XR tablet increases the risk of an overdose, and possibly seizures.
Always follow the doctor's instructions exactly to avoid any risks.
Wellbutrin has been trialed for use in ADHD, weight loss, and bipolar depression, but, so far, significant evidence only supports depression and smoking cessation.
Wellbutrin has been found to be at least as effective as other popularly prescribed antidepressant medication. There is also less chance of weight gain, sleepiness, and sexual dysfunction than with other forms of treatment.
It may even work actively against sexual dysfunction resulting from previous antidepressant use.
It can take weeks or months for Wellbutrin to relieve the symptoms of depression. There is no fixed length of time for using it, but the patient may be advised to continue taking it, even when they feel better, to prevent the symptoms from recurring.
Patients with major depressive disorder who do not respond fully to SSRIs are sometimes prescribed Wellbutrin as an additional medication.
Bupropion has been found to significantly reduce nicotine cravings. A course of treatment normally takes 7 to 12 weeks, but by day 10, the individual has often stopped smoking.
It has been described as a "safe and cost-effective smoking cessation agent" that may help 1 in 5 people stop smoking.
A person who wants to stop smoking may be prescribed a 150-mg tablet of Zyban, or possibly Chantix, twice a day. It is best to use it without nicotine replacement therapy (NRT).
In the first days after starting treatment, the person may experience agitation, restlessness, and insomnia. Reducing the dose temporarily or avoiding bedtime doses may help relieve sleeping problems.
Around 1 in 1,000 people who use Wellbutrin are at risk of a seizure.
Wellbutrin is not suitable for people who are susceptible to seizures, as it can lower the seizure threshold, making it easier for a seizure to occur.
People who should not use it include those who:
- have a history of epilepsy or other types of seizure
- are withdrawing from benzodiazepine or alcohol
- have anorexia or bulimia nervosa
- have an active brain tumor
- have experienced a head trauma
- are using drugs such as antipsychotics, antidepressants, theophylline, systemic steroids, and others that can lower the seizure threshold
Anyone who has a seizure while using Wellbutrin should stop taking the medication and inform their doctor.
Other adverse effects
The most common side effects, which affect more than 1 in 10 people, include:
One in 10 people experience:
- restlessness, tremor, shaking, and weakness
- chest pain
- fever and sweating
- weakness and tiredness
- anxiety and agitation
- high blood pressure
- ringing in the ears
- blurred vision
- intestinal problems and low appetite
Up to 1 in 100 people may have:
- raised heart rate
- weight loss
- confusion and difficulty focusing
Up to 1 in 1,000 people may have seizures.
Up to 1 in 10,000 people may experience:
- palpitations and fainting
- increased or decreased urination
- changes in blood glucose levels
- worsening of psoriasis
- skin rash, joint, and muscle pain
- jaundice, indicating an impact on the liver
Psychological effects may occur, such as feeling restless or hostile or experiencing delusions or a sense of depersonalization.
A risk of suicidal thinking and behavior has been linked to the use of several antidepressants, but it is not clear that the drugs increase the risk. The patient should be monitored for any worsening of the symptoms of depression.
For more detail on the different adverse effects, it is important to read the patient information leaflet online or inside the packaging.
Wellbutrin may not be suitable for people with:
Those who regularly drink large amounts of alcohol may not be able to take it.
These people should not use this drug without first discussing it with their doctor.
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAOIs) are also used to treat depression. Anyone who is taking a MAOI should avoid Wellbutrin.
If taken together, side effects may include confusion, restlessness, stomach discomfort or pain, high body temperature, dangerously high blood pressure, leading to headaches, dizziness, and blurred vision, and an increased risk of convulsions.
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
- Tranylcypromine (Parnate)
Wellbutrin should not be taken within 2 weeks of stopping MAOIs. Similarly, individuals should not start taking MAOIs within 2 weeks of stopping Wellbutrin.
When used to help people stop smoking, bupropion is sold as Zyban or Chantix. The Food and Drug Administration (FDA) warns that people who are taking one of these drugs to stop smoking must not take the same drug under another name to treat depression.
This will increase the dose of the same ingredients, and it may raise the risk of seizures.
Other drug interactions
Ritonavir or efavirenz are used to treat HIV infection. These can reduce the effects of Wellbutrin.
People with liver problems should discuss with their doctor whether or not Wellbutrin is suitable, before taking it.
A severe allergic reaction known as anaphylaxis can occur if a person has an allergy to any of the ingredients in Wellbutrin.
If any of the following symptoms occur, medical assistance should be sought immediately: a skin rash, itching, trouble breathing, chest pain, or swelling of the face, tongue, or throat.
Anyone experiencing any of the following reactions should seek medical advice:
- red lesions
- severe acne or a skin rash
- sores or ulcers on the skin
- fever or chills
- blistering or peeling
- loosening of the skin
Alcohol: This should be avoided or at least severely limited when using Wellbutrin, as it has been linked to neuropsychotic side effects in a few cases.
Pregnancy and breastfeeding: Mouse studies have not shown that Wellbutrin is likely to harm a pregnancy or the developing fetus. However, since drugs do not alway affect humans and animals in the same way, this drug should only be used in pregnancy and breast feeding if it cannot be avoided.
Age: It has not been approved for use under the age of 18 years.
Bipolar disorder: A major depressive episode can develop into the first signs of bipolar disorder. A doctor should monitor the patient for signs of this. Wellbutrin is not approved for use in bipolar disorder.
Driving and use of machinery: Dizziness, tiredness, blurred vision, and a false sense of wellbeing can occur when using this drug. Because of this, using heavy machinery or driving should be considered with caution.
Overdose: In rare cases, an overdose has led to seizures. Anyone who may have taken an overdose should go to the hospital.