Bupropion, commonly sold as brand names Wellbutrin and Zyban, is an antidepressant medication classified as a norepinephrine-dopamine reuptake inhibitor (NDRI). It is important to discuss medications used in conjunction with bupropion with your doctor, as adverse interactions can have dangerous consequences.

What is bupropion prescribed for?

Bupropion is commonly prescribed in the treatment of depression, including major depressive disorder, bipolar depression, and seasonal affective disorder, under the brand name Wellbutrin XL.

Bupropion can be a helpful alternative for people experiencing unwanted side effects, such as sexual dysfunction, from alternative antidepressant medications.

Additionally, it can be prescribed for smoking cessation under the name brand Zyban.[1]

Other brand names of bupropion include:

  • Aplenzin
  • Forfivo XL
  • Budeprion[1]

There are also "off-label" uses for bupropion. "Off-label" use of medication means that the Food and Drug Administration (FDA) has not yet approved its use for treating a particular condition.[3] This often happens when there is insufficient clinical data to demonstrate efficacy.

Off-label uses for bupropion include:

How does bupropion work?

Bupropion works by preventing the reuptake of norepinephrine and dopamine in the brain.[7] Researchers continue to study why and how these neurotransmitters affect depression.

Clinical studies have shown bupropion medications such as Wellbutrin XL are helpful alternatives for those with major depressive disorder who do not respond to a traditional antidepressant drug. Approximately 25% of patients who were unsuccessful with a selective serotonin reuptake inhibitor (SSRI) found relief from depression symptoms with bupropion during a clinical study.[6]

Early signs that the medication is working include better sleep, increased energy, and improved appetite.[3] However, it can take up to 8 weeks to reach the full therapeutic effects.

How is bupropion usually taken?

Since bupropion is only available by prescription, it should be used as prescribed.

Bupropion medications are taken via oral administration in tablet form. Tablets are available in extended-release options, also known as sustained-release. Sustained-release bupropion tablets are designed to dissolve more slowly, allowing them to remain in the body for longer.

Extended-release options reduce the daily amount needed and are often taken in single doses. Wellbutrin XL, for example, may only need to be taken once a day, whereas other options may require taking the medication up to three times daily.[2][8]

Extended-release tablets should never be crushed, cut, or chewed. Altering the tablet changes the way the medication metabolizes in the body.

Always talk to your healthcare provider if you miss a dose because sometimes, missed doses should be skipped. Taking an extra tablet can lead to seizures.

Because of bupropion's effects on energy levels, it is advised to avoid taking this medication near bedtime as it may cause insomnia.[2]

How long does bupropion stay in your system?

How long the effects of bupropion last depends on the dosage and amount of times the medication has been taken.[5] The longer bupropion is taken, the longer it will remain in the system.

The body eliminates this drug primarily through urine.[5]

Studies have shown bupropion use can cause false positives for amphetamines on urine drug screens.[4]

It is recommended that dosages be tapered down before stopping the use of bupropion to avoid withdrawal symptoms.

Withdrawal symptoms from bupropion may include:

  • Nausea with or without vomiting
  • Diarrhea
  • Headaches
  • Dizziness
  • Sweating
  • Chills
  • Tremors
  • Vivid dreams
  • Insomnia[2]

Bupropion side effects

The most common side effects of bupropion are:

  • Headaches
  • Insomnia
  • Stuffy nose
  • Dry mouth
  • Dizziness
  • Sore throat
  • Anxiety
  • Gastrointestinal symptoms:
  • Nausea
  • Constipation
  • Fluctuating weight (weight gain/weight loss)
  • Joint aches[8]

These common side effects often dissipate but should still be monitored by a medical professional.

Seek emergency medical help for Adverse effects from bupropion, including:

  • Seizures
  • Allergic reaction
  • Hives
  • Itching
  • Loss of consciousness
  • Fever
  • Swollen glands
  • Trouble breathing
  • Chest pain
  • Swelling[1]

The risk of seizures increases with higher dosages of bupropion. Additionally, seizures are more common in people with a pre existing seizure disorder or low seizure threshold, those using the medication in conjunction with alcohol or other substances, or those with another underlying medical risk factor.[3]

Antidepressant medications occasionally cause critical psychological side effects, particularly for children and teenagers.

Psychological side effects may include:

  • Suicidal thoughts or attempts
  • Worsening depression symptoms
  • Worsening or new anxiety symptoms (including panic attacks)
  • Feeling agitated, restless, irritable
  • Insomnia
  • Aggressive, violent behavior
  • Impulsiveness
  • Mania[8]

Any changes in mood or behavior must be discussed with the prescribing doctor as soon as possible.

Bupropion precautions

To prevent complications of taking bupropion, an evaluation should be completed that includes a full medical history before prescribing bupropion. This medical history should include any history of mental health diagnoses.

It is especially important to discuss with the doctor any history of bipolar disorder, alcohol use, eating disorder symptoms, suicidal problems, liver problems, kidney problems, or seizures. These conditions are linked to complications with bupropion use.

Bupropion use is not recommended during pregnancy or breastfeeding.[3] Always tell your doctor if you are pregnant or planning to become pregnant before taking bupropion.

Bupropion interactions

Drug interactions between bupropion and other medications can be fatal, so discussing any medications you’re currently taking with a medical professional is vital.

The use of alcohol in conjunction with bupropion has been linked to an increased risk of seizures. Seizure risk is also associated with higher dosages of bupropion and bupropion medications used in conjunction with one another.

Additional interactions increasing the risk of seizure include:

  • Other antidepressant medications, including SSRIs and MAOIs
  • Antipsychotic medications
  • Theophylline
  • Isoniazid
  • Tramadol
  • Stimulant medications (such as Adderall)
  • Steroids
  • Diabetes medications
  • Antibiotics
  • Benzodiazepines[3]

Bupropion should not be used within two weeks of taking a monoamine oxidase inhibitor (MAOI) medication.

St. John’s wort and certain vitamins, including B vitamins, sometimes suggested as natural aides for depression symptoms are linked to adverse interactions with bupropion.[1] Therefore, any herbal or vitamin supplements you use should be discussed with a medical professional before taking bupropion.

Bupropion storage

Bupropion medications should be stored at room temperature in a closed container away from natural light. These medications should be discarded when they expire or are no longer being taken.

As with all prescription medication, bupropion should be stored out of the reach of children or teenagers.

What to do if you overdose on bupropion

An overdose of bupropion can be fatal. In case of an overdose, call the Poison Help line at 1-800-222-1222 and seek immediate emergency medical care.

Bupropion overdose symptoms include:

  • Muscle stiffness
  • Psychosis
  • Irregular heartbeat
  • Respiratory problems
  • Fainting or dizziness [1]

Frequently asked questions about bupropion

Can you drink on bupropion?

No. Consuming alcohol while taking bupropion increases the risk of seizure. Any substance use, including alcohol, should be discussed openly with a healthcare provider before taking bupropion.

What does bupropion look like?

Bupropion comes as a tablet, but the appearance differs depending on the prescribed brand and form (standard-release or extended-release).

Are there any alternatives to bupropion?

Other classes of antidepressant medications may be prescribed if bupropion is found to be ineffective or inappropriate. These include selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs).

Varenicline (commonly known as Chantix) is an alternative medicine that may be prescribed for smoking cessation.

Resources:

  1. Bupropion. (n.d.). Drugs.com. Retrieved October 14, 2022, fromhttps://www.drugs.com/bupropion.html
  2. Bupropion: 7 things you should know. (n.d.). Drugs.com. Retrieved October 15, 2022, fromhttps://www.drugs.com/tips/bupropion-patient-tips
  3. Bupropion (Wellbutrin) | NAMI: National Alliance on Mental Illness. (n.d.). Retrieved October 14, 2022, fromhttps://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Bupropion-(Wellbutrin)
  4. Casey, E. R., Scott, M. G., Tang, S., & Mullins, M. E. (2011). Frequency of false positive amphetamine screens due to bupropion using the Syva EMIT II immunoassay. Journal of medical toxicology: official journal of the American College of Medical Toxicology, 7(2), 105–108.https://doi.org/10.1007/s13181-010-0131-5
  5. Huecker MR, Smiley A, Saadabadi A. Bupropion. [Updated 2022 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK470212/
  6. Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Stewart, J. W., Nierenberg, A. A., Thase, M. E., Ritz, L., Biggs, M. M., Warden, D., Luther, J. F., Shores-Wilson, K., Niederehe, G., Fava, M., & STAR*D Study Team (2006). Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. The New England Journal of Medicine, 354(12), 1231–1242.https://doi.org/10.1056/NEJMoa052963
  7. Stahl, S. M., Pradko, J. F., Haight, B. R., Modell, J. G., Rockett, C. B., & Learned-Coughlin, S. (2004). A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor. Primary Care Companion to the Journal of Clinical Psychiatry, 6(4), 159–166. Retrieved October 14, 2022, fromhttps://pubmed.ncbi.nlm.nih.gov/15361919/
  8. WELLBUTRIN XL®, HCP Information, Proven Efficacy, MDD & SAD. (n.d.). Retrieved October 15, 2022, fromhttps://www.wellbutrinxl.com/about