Wellbutrin XL®, Budeprion XL®, Forfivo®
Zyban®, Buproban® (for smoking cessation)
Generic name: bupropion (byoo PROE pee on)
Medication class: Norepinephrine-dopamine reuptake inhibitor antidepressant
All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.
What is Wellbutrin® and what does it treat?
Bupropion is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder (MDD), seasonal affective disorder (SAD), and to help people stop smoking.
Symptoms of depression include:
Depressed mood - feeling sad, empty, or tearful
Feeling worthless, guilty, hopeless, and helpless
Loss of interest or pleasure in your usual activities
Sleep and eat more or less than usual (for most people it is less)
Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
Psychomotor agitation (‘nervous energy’)
Psychomotor retardation (feeling like you are moving and thinking in slow motion)
Suicidal thoughts or behaviors
SAD is a type of depression that occurs at the same time every year. It usually starts in the fall and may continue through the winter.
What is the most important information I should know about Wellbutrin®?
Do not stop taking bupropion even when you feel better. Only your healthcare provider can determine the length of treatment that is right for you.
Missing doses of bupropion may increase your risk for relapse in your symptoms.
Stopping bupropion abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).
Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for "switching" from depression into mania. Symptoms of mania include "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).
Are there specific concerns about Wellbutrin® and pregnancy?
If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.
Caution is advised with breastfeeding since bupropion does pass into breast milk.
What should I discuss with my healthcare provider before taking Wellbutrin®?
Symptoms of your condition that bother you the most
If you have thoughts of suicide or harming yourself
Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
Any other psychiatric or medical problems you have, including a history of bipolar disorder
All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
If you are pregnant, plan to become pregnant, or are breast-feeding
If you drink alcohol or use drugs
How should I take Wellbutrin®?
Bupropion is usually taken 1, 2, or 3 times per day with or without food. The number of times each day you take the medication will depend on which product your healthcare provider has prescribed. If you have been instructed to take it more than once daily, it is usually taken with 4-6 hours between doses.
You should not take more than one bupropion product at the same time.
Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
The dose usually ranges from 150 mg to 450 mg. Only your healthcare provider can determine the correct dose for you.
The sustained release and extended release forms should be swallowed whole. They should not be chewed, crushed, or broken.
Consider using a calendar, pillbox, alarm clock, or cell to help you remember to take your medication. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.
What happens if I miss a dose of Wellbutrin®?
If you miss a dose of bupropion, take it as soon as you remember if it is still early in the day. Do not take a missed dose after 5:00 PM, as this may interfere with sleep. Do not take a missed dose of extended-release forms after 2:00 PM, as this may interfere with sleep. Discuss missed doses with your healthcare provider. Do not double your next dose or take more than what is prescribed
What should I avoid while taking Wellbutrin®?
Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.
What happens if I overdose with Wellbutrin®?
If an overdose occurs, call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.
A specific treatment to reverse the effects of bupropion does not exist.
What are the possible side effects of Wellbutrin®?
- Common Side Effects:
- Headache, weight loss, dry mouth, trouble sleeping, nausea, feeling dizzy, constipation, fast heartbeat
- Rare Side Effects
- Skin rash, sweating, ringing in the ears, feeling shaky, muscle pain, hallucinations, anxiety
- Serious Side Effects
- Seizure: Increased risk with history of head injury, brain tumor, liver disease, alcohol dependence, or eating disorder
- Cardiac (heart) effects: high blood pressure, increased heart rate
Are there any risks of taking Wellbutrin® for long periods of time?
To date, there are no known problems associated with long term use of bupropion. It is a safe and effective medication when used as directed.
What other medications may interact with Wellbutrin®?
Bupropion should not be taken with or within 2 weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), rasagiline (Azilect®), and selegeline (Emsam®).
Increased risk of seizure when combined with:
Other antidepressants or antipsychotics
Theophylline (Uniphyl®, Theo-Dur®)
Medications that lower blood sugar (including insulin)
Some antibiotics (ciprofloxacin (Cipro®), isoniazid (Nydrazid®)
Abrupt discontinuation of benzodiazepines (e.g., lorazepam (Ativan®)
Bupropion may increase the levels and effects of:
Certain antidepressants: nortriptyline (Pamelor®), imipramine (Tofranil®), desipramine (Norpramin®), paroxetine (Paxil®), fluoxetine (Prozac®), sertraline (Zoloft®)
Certain antipsychotics: haloperidol (Haldol®), aripiprazole (Abilify®), thioridazine (Mellaril®)
Beta-blockers such as metoprolol (Toprol XL®, Lopressor®) and propranolol (Inderal®)
Certain antiarrhythmics: propafenone (Rythmol®), flecainide (Tambocor®)
How long does it take for Wellbutrin® to work?
Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.
Provided by the College of Psychiatric and Neurologic Pharmacists
Summary of Black Box Warning:
Suicidal Thoughts or Actions in Children and Adults
Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.
Patients with major depressive disorder (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. This risk may persist until significant remission occurs.
In short-term studies, antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults age 65 and older taking antidepressants have a decreased risk of suicidality.
Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional.
All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.