Wellbutrin

Wellbutrin is a prescription medication used to treat depression. Wellbutrin belongs to a group of drugs called antidepressants, which work by affecting certain natural chemicals in the brain. 

This medication comes in tablet form and is usually taken 3 or 4 times daily.

Common side effects of Wellbutrin include agitation, dry mouth, headache, and nausea. Wellbutrin can also cause dizziness. Do not drive or operate heavy machinery until you know how this medication affects you.

Wellbutrin is a prescription medication used to treat depression.

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

• GlaxoSmithKline LLC

Serious side effects have been reported with Wellbutrin. See the “Wellbutrin Precautions” section.

The most common side effects of Wellbutrin are:

• Nervousness
• Dry mouth
• Constipation
• Headache
• Nausea or vomiting
• Dizziness
• Heavy sweating
• Shakiness (tremor)
• Trouble sleeping
• Blurred vision
• Fast heartbeat

If you have nausea, take your medicine with food.

If you have trouble sleeping, do not take your medicine too close to bedtime.

This is not a complete list of Wellbutrin side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• MAO inhibitors (isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate))
• amantadine (Symmetrel)
• medications that increase the activity of the enzyme CYP2B6 such as ritonavir, lopinavir, efavirenz, carbamazepine, phenobarbital and phenytoin
• medications for irregular heartbeat such as flecainide (Tambocor) and propafenone (Rythmol)
• medications for mental illness such as haloperidol (Haldol), risperidone (Risperdal), and thioridazine (Mellaril)
• other antidepressants such as venlafaxine (Effexor), desipramine (Norpramin), fluoxetine (Prozac), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil) and sertraline (Zoloft)
• levodopa
• amantadine

This is not a complete list of all drug interactions of Wellbutrin. Ask your doctor for more information.

What is the most important information I should know about this medication, depression, and other serious mental illnesses, and suicidal thoughts or actions?

1. Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.
2. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions.
3. How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?

• Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
• Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
• Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.
• Call a healthcare provider right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:
• thoughts about suicide or dying
• attempts to commit suicide
• new or worse depression
• new or worse anxiety
• feeling very agitated or restless
• panic attacks
• trouble sleeping (insomnia)
• new or worse irritability
• acting aggressive, being angry, or violent
• acting on dangerous impulses
• an extreme increase in activity and talking (mania)
• other unusual changes in behavior or mood

What else do I need to know about Wellbutrin when being treated for depression?

• Never stop this medication without first talking to a healthcare provider. Stopping this medication suddenly can cause other symptoms.
• Antidepressants are medicines used to treat depression and other illnesses. It is important to discuss all the risks of treating depression and also the risks of not treating it. Patients and their families or other caregivers should discuss all treatment choices with the healthcare provider, not just the use of antidepressants.
• Antidepressant medicines have other side effects. Talk to the healthcare provider about the side effects of the medicine prescribed for you or your family member.
• Antidepressant medicines can interact with other medicines. Know all of the medicines that you or your family member takes. Keep a list of all medicines to show the healthcare provider. Do not start new medicines without first checking with your healthcare provider.
• Not all antidepressant medicines prescribed for children are FDA approved for use in children. Talk to your child's healthcare provider for more information.

Quitting Smoking, Quit-Smoking Medications, Changes in Thinking and Behavior, Depression, and Suicidal Thoughts or Actions

Although Wellbutrin is not a treatment for quitting smoking, it contains the same active ingredient (bupropion hydrochloride) as Zyban which is used to help patients quit smoking. Some people have had changes in behavior, hostility, agitation, depression, suicidal thoughts or actions while taking bupropion to help them quit smoking. These symptoms can develop during treatment with bupropion or after stopping treatment with bupropion.

If you, your family member, or your caregiver notice agitation, hostility, depression, or changes in thinking or behavior that are not typical for you, or you have any of the following symptoms, stop taking this medication and call your healthcare provider right away:

• thoughts about suicide or dying
• an extreme increase in activity and talking (mania)
• attempts to commit suicide
• abnormal thoughts or sensations
• new or worse depression
• seeing or hearing things that are not there (hallucinations)
• new or worse anxiety
• panic attacks
• feeling people are against you (paranoia)
• feeling very agitated or restless
• feeling confused
• acting aggressive, being angry, or violent
• other unusual changes in behavior or mood
• acting on dangerous impulses

What Other Important Information Should I Know About This Medication?

• Seizure: There is a chance of having a seizure (convulsion, fit) with Wellbutrin, especially in people with certain medical problems or who take certain medicines.
• High blood pressure (hypertension): Some people get high blood pressure, that can be severe, while taking Wellbutrin. The chance of high blood pressure may be higher if you also use nicotine replacement therapy (such as a nicotine patch) to help you stop smoking.
• Manic episodes. Some people may have periods of mania while taking Wellbutrin, including:
  • Greatly increased energy
  • Severe trouble sleeping
  • Racing thoughts
  • Reckless behavior
  • Unusually grand ideas
  • Excessive happiness or irritability
  • Talking more or faster than usual
• Visual problems.
  • eye pain
  • changes in vision
  • swelling or redness in or around the eye

Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are.

• Severe allergic reactions: Some people have severe allergic reactions to Wellbutrin. Stop taking Wellbutrin and call your doctor right away if you get a rash, itching, hives, fever, swollen lymph glands, painful sores in the mouth or around the eyes, swelling of the lips or tongue, chest pain, or have trouble breathing. These could be signs of a serious allergic reaction.

• Unusual thoughts or behaviors: Some patients have unusual thoughts or behaviors while taking Wellbutrin, including delusions (believe you are someone else), hallucinations (seeing or hearing things that are not there), paranoia (feeling that people are against you), or feeling confused. If this happens to you, call your doctor.

Do not take Wellbutrin if you:

• have or had a seizure disorder or epilepsy.
• are taking any other form of bupropion already (immediate-release, sustained-release, extended-release tablets)
• drink a lot of alcohol and abruptly stop drinking, or use medicines called sedatives (these make you sleepy) or benzodiazepines and you stop using them all of a sudden.
• have taken within the last 14 days medicine for depression called a monoamine oxidase inhibitor (MAOI), such as Nardil (phenelzine sulfate), Parnate (tranylcypromine sulfate), or Marplan (isocarboxazid).
  • do not take an MAOI within 2 weeks of stopping Wellbutrin unless directed to do so by your healthcare provider.
  • do not start Wellbutrin if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your healthcare provider.
• have or had an eating disorder such as anorexia nervosa or bulimia.
• are allergic to the active ingredient in Wellbutrin or to any of the inactive ingredients.

Do not drink a lot of alcohol while taking Wellbutrin. If you usually drink a lot of alcohol, talk with your doctor before suddenly stopping. If you suddenly stop drinking alcohol, you may increase your risk of having seizures.

Do not drive a car or use heavy machinery until you know how Wellbutrin affects you. Wellbutrin can impair your ability to perform these tasks.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Wellbutrin there are no specific foods that you must exclude from your diet when receiving Wellbutrin.

Tell your doctor if you have ever had depression, suicidal thoughts or actions, or other mental health problems.

Tell your doctor about your other medical conditions including if you:

• have liver problems, especially cirrhosis of the liver.
• have kidney problems.
• have, or have had, an eating disorder such as anorexia nervosa or bulimia.
• ever had depression, suicidal thoughts or actions, or other mental health problems.
• have had a head injury.
• have had a seizure (convulsion, fit).
• have a tumor in your nervous system (brain or spine).
• have had a heart attack, heart problems, or high blood pressure.
• are a diabetic taking insulin or other medicines to control your blood sugar.
• drink alcohol.
• abuse prescription medicines or street drugs.
• are pregnant or plan to become pregnant.
• are breastfeeding. Wellbutrin passes into your milk in small amounts.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Many medicines increase your chances of having seizures or other serious side effects if you take them while you are using Wellbutrin.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed. The active ingredient in Wellbutrin, bupropion, passes through breast milk. It is not known if Wellbutrin can harm your baby.

Take Wellbutrin exactly as prescribed by your doctor.

• Take Wellbutrin at the same time each day.
• Wellbutrin immdiate release tablet is usually taken 3 times daily.
• Take your doses of Wellbutrin at least 6 hours apart.
• Do not chew, cut, or crush Wellbutrin tablets.
• You may take Wellbutrin with or without food.
• If you miss a dose, do not take an extra tablet to make up for the dose you forgot. Wait and take your next tablet at the regular time. This is very important. Too much Wellbutrin can increase your chance of having a seizure.
• Do not take any other medicines while using Wellbutrin unless your doctor has told you it is okay.
• For treating depression, it may take several weeks for you to feel that Wellbutrin is working. Once you feel better, it is important to keep taking Wellbutrin exactly as directed by your doctor. Call your doctor if you do not feel Wellbutrin is working for you.
• Do not change your dose or stop taking Wellbutrin without talking with your doctor first.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• how you respond to this medication
• your kidney function
• your liver function

The recommended starting dose of Wellbutrin (bupropion hydrochloride) is 200 mg per day, given as 100 mg twice daily.

• Your doctor will increase your dose slowly to reduce the risk for seizures. 
• The recommended dose is 300 mg per day as 100 mg 3 times daily.
• The maximum dose is 450 mg per day, given as 150 mg 3 times a day. 
• If your liver and/or kidney does not work well, your dose and the number of times you take Wellbutrin will be reduced. 

If you take too much Wellbutrin call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If Wellbutrin is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

 Buproprion is available in three different types of tablets.

1. Buproprion tablet which is available in both 75mg and 150mg strengths.  This tablet may be taken every eight hours or up to three times a day.
2. Buproprion SR (Sustained Release) is available as a 100mg, 150mg, and 200mg tablet. The Sustained Release coating allows for this medication to be taken every twelve hours or twice a day.
3. Buproprion XL (Extended Release) is available as a 150mg, 300mg, and 450mg tablet. The Extended Release coating on allows for this medication to taken once every twenty four hours or once a day. The 450mg is available only as a brand name medication called Forfivo XL.

• Store Wellbutrin at room temperature between 59°F and 86°F (15°C to 30°C).
• Keep Wellbutrin tablets dry and out of the light.
• Keep Wellbutrin and all medicines out of the reach of children.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS; AND NEUROPSYCHIATRIC REACTIONS

SUICIDALITY AND ANTIDEPRESSANT DRUGS

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials. These trials did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in subjects over age 24; there was a reduction in risk with antidepressant use in subjects aged 65 and older [see Warnings and Precautions (5.1)].

In patients of all ages who are started on antidepressant therapy, monitor closely for worsening, and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber.

NEUROPSYCHIATRIC REACTIONS IN PATIENTS TAKING BUPROPION FOR SMOKING CESSATION

Serious neuropsychiatric reactions have occurred in patients taking bupropion for smoking cessation[see Warnings and Precautions (5.2)]. The majority of these reactions occurred during bupropion treatment, but some occurred in the context of discontinuing treatment. In many cases, a causal relationship to bupropion treatment is not certain, because depressed mood may be a symptom of nicotine withdrawal. However, some of the cases occurred in patients taking bupropion who continued to smoke. Although WELLBUTRIN® is not approved for smoking cessation, observe all patients for neuropsychiatric reactions. Instruct the patient to contact a healthcare provider if such reactions occur.