Bupropion
WELLBUTRIN
What it isNorepinephrine-dopamine reuptake inhibitor; depression and smoking cessation.
Why this oneFar less sexual dysfunction and weight gain than SSRIs, which is why it is added to or substituted for one.
What limits itLowers the seizure threshold, so avoid in eating disorders and with alcohol withdrawal. A strong CYP2D6 inhibitor.
FDA-approved for
- depression (1985)
- smoking cessation (1997)
- seasonal affective disorder (2006)
Off-label
- ADHD
- antidepressant sexual dysfunction
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder | Adults | 150 mg QAM | 300 mg QD | 450 mg/day |
| Seasonal affective disorder (prevention) | Adults | 150 mg QD | 300 mg QD | 300 mg/day |
Titration MDD: may increase to 300 mg QD after 4 days; SAD: may increase to 300 mg QD after 7 days
Renal Consider reduced dose and/or frequency (GFR <90 mL/min)
Hepatic Moderate-severe (Child-Pugh 7–15): max 150 mg every other day; mild (5–6): consider reduced dose/frequency
Instructions
- Swallow whole; do not crush, divide, or chew
- Take in the morning, with or without food
- Increase dose gradually to reduce seizure risk; do not exceed 450 mg/day
- Taper (300 mg to 150 mg QD) before discontinuing
Contraindications
- Seizure disorder
- Current or prior bulimia or anorexia nervosa
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
- MAOIs (concurrently or within 14 days) due to risk of hypertensive crisis
Cautions
- Neuropsychiatric adverse events (mood changes, psychosis, suicidal ideation) in smoking cessation use
- Seizure (dose-related) — limit dose and titrate gradually
- Hypertension/elevated blood pressure
- Activation of mania/hypomania — screen for bipolar disorder
- Psychosis and other neuropsychiatric reactions
- Angle-closure glaucoma
Adverse reactions
- Dry mouth
- Nausea
- Insomnia
- Dizziness
- Pharyngitis
- Agitation, anxiety, tremor
- Palpitation, sweating, tinnitus
- Myalgia, anorexia, urinary frequency, rash
Pregnancy Epidemiologic data do not show increased overall malformation risk; weigh against risks of untreated depression
Lactation Bupropion and metabolites present in human milk (~2% maternal dose); seizures reported in breastfed infants
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$300–$2,500/month
Generic entry1999
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityDose-related seizures and delayed cardiotoxicity are prominent in overdose, especially with extended-release products.
Active metabolites
Mechanism of action: Bupropion ballicule
Open Bupropion in the interactive console ↗
Memory aids: mascots and interaction avatars
Strong CYP2D6 inHibitor
Skinny → weight loss possible
