Bad side effects from wellbutrin

Wellbutrin side effects and how to avoid them

Wellbutrin treats major depressive disorder (MDD), seasonal affective disorder (SAD), and assists with smoking cessation

Wellbutrin (bupropion hydrochloride) is a brand-name prescription drug used for the treatment of major depressive disorder (MDD), the prevention of seasonal affective disorder (SAD), and smoking cessation, in addition to several off-label uses. As an antidepressant medication, Wellbutrin works by increasing the amount of norepinephrine and dopamine in the brain. These substances are neurotransmitters that are involved with regulating mood, emotions, memory, and motivation, and by increasing the levels of these neurotransmitters, Wellbutrin can help manage mental health conditions.

Brand-name Wellbutrin is available as a sustained-release (Wellbutrin SR) or extended-release (Wellbutrin XL) tablet, and generic Wellbutrin is available as an immediate-release tablet in addition to a sustained- or extended-release tablet. Bupropion might also be sold under other brand names including Forfivo XL and Aplenzin (bupropion hydrobromide), as well as Zyban, which has recently been discontinued. Although Wellbutrin works differently than other antidepressants, it does have side effects and may not be suitable for some people with pre-existing medical conditions.

RELATED: What is Wellbutrin?

Common side effects of Wellbutrin

The most common side effects of Wellbutrin are:

Trouble sleeping
Headache
Agitation
Dry mouth
Constipation
Weight loss or weight gain
Migraine
Nausea
Vomiting
Excessive sweating
Tremor
Dizziness
Blurred vision
Fast heartbeat
Joint aches
Sore throat

Serious side effects of Wellbutrin

Possible side effects of Wellbutrin that can be serious or even life-threatening include:

Worsened depression
Suicidal thoughts and behaviors
Homicidal thoughts
Neuropsychiatric events (psychosis, mania, hallucinations, and panic attacks)
Seizures
Severe high blood pressure (hypertension)
Heart problems, including irregular heartbeat
Angle-closure glaucoma
Liver problems
Visual problems, such as changes in vision
Severe allergic reactions

Wellbutrin and suicide

Wellbutrin has a black box warning that highlights a risk of worsening depression and suicidal thoughts or behaviors in children, teens, and young adults. The incidence of these adverse effects is between 0.1% and 1%, although older adults are at a lower risk of this effect. Patients and caregivers should watch behavior and mood closely and call a healthcare provider at any signs of suicidality, such as:

Talks of suicide or dying
Suicide attempts
New or worsened depression, anxiety, or irritability
Agitation and restlessness
Extreme dietary changes
Irritability
Trouble sleeping
Increased use of illicit substances or alcohol
Unusual, aggressive, or violent behaviors
Isolation from friends and family

Wellbutrin and angle-closure glaucoma

Angle-closure glaucoma is a medical emergency that comes on suddenly when the opening, or angle, between the iris and the cornea is blocked, causing fluid pressure to build up rapidly in the eye. This opening allows fluid to drain from the eye, but people with uncorrected “narrow angles” between the iris and the cornea are particularly vulnerable to closure. Because angle-closure glaucoma can rapidly develop into permanent vision loss, you should immediately stop taking Wellbutrin and go to an emergency room at any sign of angle-closure glaucoma, such as:

Eye pain
Changes in vision
Swelling or redness in or around the eye

Wellbutrin and neuropsychiatric events

When taken for smoking cessation, Wellbutrin has been reported to cause neuropsychiatric events, such as depression, anxiety, panic attacks, hostility, and even psychosis or hallucinations. The risk of experiencing these events can vary, but people with a history of mental health problems may be at a high risk of experiencing these events. Patients and caregivers should monitor behaviors and mood closely and call a healthcare provider at any sign of psychiatric problems.

Wellbutrin and weight loss

Weight loss is a common side effect of Wellbutrin, affecting 14% to 23% of people who take the medication. Anorexia—loss of appetite—is also commonly experienced, with an incidence between 1% and 18%. For this reason, some healthcare professionals may prescribe bupropion off-label for weight loss or weight loss maintenance, while others consider it the antidepressant of choice for patients diagnosed with both depression and obesity. The U.S. Food and Drug Administration (FDA) has approved at least one bupropion drug for weight loss: Contrave, a combination of bupropion and naltrexone, a drug normally used to treat opioid or alcohol abuse.

How long do side effects last?

With a half-life of 14 hours when taken as a single dose and 21 hours when taken on a consistent basis, bupropion and its active metabolites can remain in the body for three or four days. However, side effects are usually mild and temporary. Side effects of bupropion can last a couple of days or weeks as the body gets used to the drug. Consult a healthcare provider if side effects last longer than two to three weeks, or if side effects are particularly bothersome or severe.

Some side effects may take longer to resolve or require medical attention. Serious adverse effects, such as severe allergic reactions, angle-closure glaucoma, irregular heartbeat, heart attack, seizures, severe high blood pressure, and severely low blood sodium levels will require medical attention. Some of these side effects, such as angle-closure glaucoma or heart attack, may have lifelong complications.

Suicidality, worsening of depression, mood changes, mania, hostility, and other neuropsychiatric events can occur with the use of bupropion. In many cases, Wellbutrin will be discontinued. However, these symptoms may be due to pre-existing mental health problems, so long-term psychiatric treatment for other mental health problems may be recommended.

Wellbutrin contraindications & warnings

Wellbutrin affects the brain and body in different ways, and it can cause problems in people with a variety of pre-existing conditions.

Abuse and dependence

The U.S. Food and Drug Administration (FDA) does not consider Wellbutrin a drug that can cause physical dependence, abuse, or tolerance. However, Wellbutrin can produce a mild amphetamine-like reaction. For this reason, Wellbutrin is commonly abused as a street drug and sometimes referred to as “the poor man’s cocaine.” This medication also carries a risk for psychological dependence, but the most serious problems are side effects, particularly seizures, when people abuse bupropion by snorting the drug, injecting the drug, or taking it in large doses.

Overdose

A Wellbutrin overdose is potentially serious and will often require medical attention. The most common side effect of a Wellbutrin overdose is seizures, but other symptoms include:

Hallucinations
Loss of consciousness
Fast heartbeat
Irregular heartbeat
Overactive reflexes
Convulsions

When taken in excessive amounts in combination with other drugs, Wellbutrin may also cause fever, muscle rigidity, low blood pressure, stupor, coma, and respiratory failure.

Restrictions

Some medical conditions make taking Wellbutrin too hazardous:

Anyone with allergies to bupropion will not be prescribed Wellbutrin.
Because of an increased risk of seizures, Wellbutrin is never given to people with a history of seizures, a prior diagnosis of an eating disorder, such as anorexia or bulimia, or anyone undergoing abrupt withdrawal from alcohol, barbiturates, benzodiazepines, or antiepileptic medications.

Other pre-existing conditions may cause problems, so healthcare providers will prescribe Wellbutrin cautiously and watch carefully for side effects.

Because of the increased risk of suicidal thoughts and behaviors, people younger than the age of 25 should be carefully watched for signs of worsening depression, unusual behaviors, or thoughts about suicide or dying. Any mood changes, depression, or suicidality need to be reported to the prescribing healthcare professional as soon as they’re noticed.
Because of an increased risk for seizures, people with risk factors for seizures may need to be carefully monitored. These risk factors include head injury, CNS infection, severe stroke, arteriovenous malformation, and drug or alcohol abuse.
People with a history of mental health problems will be monitored for neuropsychiatric side effects, particularly when taking Wellbutrin for smoking cessation.
All antidepressants can provoke mania or hypomania in people with bipolar disorder, so people with bipolar disorder should be closely monitored for behavioral changes.
People with high blood pressure or a recent heart attack may require close monitoring of blood pressure.
People who have uncorrected narrow angles are at a higher risk of narrow-angle glaucoma when taking Wellbutrin, so they should watch for and report any eye problems.
People with Tourette’s syndrome or with a tic disorder may be at risk for new or worsening tics when taking Wellbutrin.
Wellbutrin may require dose modifications and monitoring in people with liver or kidney problems.

Pregnancy and nursing

There is no evidence that bupropion increases the risk of birth defects, miscarriage, or other problems when taken during pregnancy. Because untreated depression does have pregnancy risks, women should get medical advice from a healthcare professional about the safety and benefits of taking Wellbutrin during pregnancy.

Nursing mothers are advised to be cautious about taking Wellbutrin. Bupropion and its active metabolites are present in breast milk, but healthcare providers are uncertain about its effects on the baby. Before taking Wellbutrin, women who are breastfeeding should talk to a healthcare professional about its benefits and risks.

Children

The Food and Drug Administration (FDA) has not approved bupropion for anyone younger than the age of 18. Some healthcare providers, however, may prescribe Wellbutrin off-label to children as young as 11 years of age, but these children are at an increased risk of worsening depression, suicidal thoughts, and suicidal behaviors.

Seniors

People older than 65 can take Wellbutrin in the same doses as younger adults, but doses may be modified in some older adults if the person has liver or kidney problems.

Wellbutrin interactions

Most Wellbutrin drug interactions are minor, but some are serious enough to require monitoring, dosing changes, or avoiding the drug combination altogether.

Wellbutrin is never combined with some drugs because of the potential hazards. These include:

MAO inhibitors: Because of the risk for high blood pressure or seizures, Wellbutrin is never taken with monoamine oxidase inhibitors (MAOIs), a small family of drugs that includes the antidepressants isocarboxazid, phenelzine, tranylcypromine, and selegiline. Other examples of MAOIs include the cancer drug procarbazine, the antibiotic linezolid, and methylene blue injections.
Anti-seizure medications, barbiturates, and benzodiazepines: Because of an increased risk of seizures, treatment with Wellbutrin is not started if these medications have been used excessively or discontinued suddenly.
Other precautions: Because of the increased risk of serious heart rhythm problems, Wellbutrin is not recommended to be taken with the antipsychotic drugs pimozide or thioridazine.

Some drugs that lower the seizure threshold may need to be avoided. These include:

Antipsychotics
Tricyclic antidepressants
Appetite suppressants
Certain opioids
Systemic corticosteroids
Theophylline
Stimulants

Bupropion raises dopamine levels in the brain. When combined with similar drugs (dopaminergic drugs), dopamine can rise to toxic levels. So both levodopa and amantadine should be used cautiously with bupropion.

Bupropion can block the body’s metabolism of other drugs. As a result, the concentration of other drugs in the body can increase, raising the risk of side effects. Either these drugs must be stopped or the doses must be changed. These include:

Tricyclic antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Antipsychotics
Beta blockers
Certain types of heart rhythm medications

Finally, alcohol mixed with bupropion can provoke neuropsychiatric events. The use of alcohol should be avoided or minimized when taking Wellbutrin.

How to avoid Wellbutrin side effects

1. Take Wellbutrin as directed

Take Wellbutrin as instructed. The typical dose is 300 mg a day. Don’t skip a dose, but if you do, don’t make up that dose. Wait until the next scheduled dose and take that dose as planned.

2. Tell the healthcare provider about all medical conditions

To avoid potentially serious side effects, tell the prescribing healthcare professional about all medical conditions, especially if you’ve had a history of:

Eating disorders
Suicide attempts
Depression or other mental health problems, such as mania, hypomania, or bipolar disorder
Heart disease, high blood pressure, or recent heart attack
Liver problems
Kidney problems
Head injuries
Seizures
Brain or spinal tumors
Diabetes
Alcohol or illicit drug use
Pregnancy or pregnancy plans
Breastfeeding or plans to breastfeed

3. Tell the healthcare provider about all medications

Drug interactions can also cause side effects, so tell your healthcare provider about all prescription and over-the-counter medications you take, especially:

MAO inhibitors
Anti-seizure medications
Sedatives
Benzodiazepines
Opioids

4.

Do not drink alcohol

Drinking alcohol when being treated with Wellbutrin can cause neuropsychiatric side effects. Avoid alcohol entirely or drink in moderation according to your doctor’s instructions.

5. Be careful about driving and other risky activities at first

Avoid driving cars or operating machinery for a few days until you’re familiar with Wellbutrin and how it affects your body.

6. Eat a healthy diet

To avoid weight loss or weight gain, eat a healthy diet and carefully monitor weight while taking Wellbutrin. A dietitian or nutritionist may be able to help if appetite and weight changes become a problem while taking this medication.

7. Talk to a healthcare provider before discontinuing Wellbutrin

The sudden discontinuation of Wellbutrin can cause unpleasant withdrawal effects. Seek medical advice if Wellbutrin does not seem to be working or the side effects become hard to manage. Upon discontinuing Wellbutrin, a healthcare provider may recommend tapering, or gradually lowering, the dose to help prevent problems when stopping Wellbutrin.

Related resources for Wellbutrin side effects:

15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL, Primary Care Companion to The Journal of Clinical Psychiatry
Bupropion compound summary, U.S. National Library of Medicine
Bupropion drug summary, Prescriber’s Digital Reference
“Narrow angles” a tip-off to eyesight risk, Harvard Health Publishing
One antidepressant shown to control weight during a 2-year study, Science Daily
Wellbutrin SR, Epocrates
Wellbutrin SR prescribing information, U.S. National Library of Medicine
What is naltrexone?, UAMS Psychiatric Research Center

Bupropion (Wellbutrin) | NAMI: National Alliance on Mental Illness

Brand names:

Wellbutrin SR®
- Tablets: 100 mg, 150 mg, 200 mg
Wellbutrin XL®
- Tablets: 150 mg, 300 mg
Zyban®
- Tablets: 150 mg
Forfivo XL®
- Tablets: 450 mg
Aplenzin®
- Tablets: 174 mg, 348 mg, 522 mg
Bupropion hydrochloride
- Immediate release tablets: 75mg, 100 mg
- Sustained release tablets: 100 mg, 150 mg, 200 mg
- Extended release tablets: 150 mg, 300 mg
Bupropion hydrobromide
- Extended release tablets: 174 mg, 348 mg, 522 mg

Generic name: bupropion (byoo PRO pee on)

All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

What Is Bupropion 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 quit smoking (smoking cessation).

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 mainly during the autumn-winter season. Although the common term SAD is now referred to as Major Depression with Seasonal Pattern, this fact sheet will continue to use SAD as it is more commonly known.

Bupropion may also be helpful when prescribed “off-label” for bipolar disorder, attention deficit hyperactivity disorder (ADHD, and sexual dysfunction due to SSRI antidepressants. “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.

What Is The Most Important Information I Should Know About Bupropion?

After starting bupropion, symptoms gradually decrease over a period of weeks. In MDD and SAD, sleep and other physical symptoms may improve before there is noticeable improvement in mood or interest in activities. Once symptoms are under control, MDD usually requires long-term treatment to help prevent the return of depressive symptoms. If you are using bupropion for SAD or smoking cessation, the length of your treatment may be shorter. With input from you, your health care provider will assess how long you will need to take the medicine.

Do not stop taking bupropion or change your dose without talking with your health care provider first.

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 Bupropion And Pregnancy?

If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions, each with risks and benefits as they relate to how the illness, medications, and risks to the fetus may interact. 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.

Bupropion has also been evaluated for smoking cessation during pregnancy and is recommended only after other therapies have failed.

Caution is advised with breastfeeding since bupropion does pass into breast milk.

What Should I Discuss With My Health Care Provider Before Taking Bupropion?

Symptoms of your condition that bother you 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 an adjustment in the medication.
Any other psychiatric or medical problems you have, including a history of bipolar disorder
All other medications you are currently taking and any medication allergies you have. This will help your prescriber assess for potential drug interactions.
Other non-medication treatment you are receiving (such as psychotherapy (i.e., 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 breastfeeding
If you drink alcohol or use drugs

How Should I Take Bupropion?

Bupropion hydrochloride is available in 3 different forms: immediate release (IR), sustained release (SR), and extended release (XL).

Bupropion IR is usually taken 2 or 3 times per day with 4-6 hours between doses. The dose usually ranges from 100 mg twice daily to 150 mg three times daily, with the last dose taken mid-afternoon.

Bupropion SR is usually taken twice daily in the morning and mid-afternoon. The dose usually ranges from 100 mg twice daily up to 200 mg twice daily.

Bupropion XL is usually taken once daily in the morning. The dose ranges from 150 mg to 450 mg.

Bupropion hydrobromide (Aplenzin®) is usually taken once daily in the morning. The dose ranges from 174 mg to 522 mg.

While there are dose ranges for each form, your health care provider will determine the form and dose that is right for you based on your response.

The dose for SAD is bupropion XL 150 mg once daily in the morning. The dose may be increased to 300 mg once daily.

The dose for smoking cessation is bupropion SR 150 mg once daily for 3 days and then twice daily for 7 to 12 weeks.

You should not take more than one product that contains bupropion, including the products that are used to quit smoking. Do not take more than your prescribed dose since higher doses may increase your risk of having a seizure. Since quickly increasing the dose of bupropion can cause seizures in some people, your doctor will slowly increase your dose.

You can take bupropion on an empty stomach or with food. The SR and XL forms should be swallowed whole — not chewed, crushed, or broken — so that the medication can work correctly in your body and to reduce the risk of serious side effects. The tablet shell from the SR and XL forms may appear in your feces.

Consider using a calendar, pillbox, alarm clock, or cell phone alert 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 Bupropion?

For bupropion IR or SR, if you miss a dose, take it as soon as you remember. Take the remaining doses for the day at evenly spaced times at least 4 hours apart. DO NOT take 2 doses at once. You should not take more than your prescribed dose and doing so may increase your risk of having a seizure.

For bupropion XL, do not take an extra tablet to make up for the dose you forgot. Wait and take your next dose at your regular time the next day.

What Should I Avoid While Taking Bupropion?

Avoid drinking alcohol or using illegal drugs while you are taking bupropion because the beneficial effects of the medication may be decreased and the risk of seizures may be increased. If you are dependent on drugs or alcohol and would like to stop, consult your healthcare provider for help. Abruptly stopping these substances can result in a seizure, especially when taking bupropion.

What Happens If I Overdose With Bupropion?

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.

What Are The Possible Side Effects Of Bupropion?

Common side effects

Headache, weight loss, dry mouth, trouble sleeping (insomnia), nausea, dizziness, constipation, fast heartbeat, and sore throat. These will often improve over the first week or two as you continue to take the medication.

Rare/serious side effects

Less than 10% of patients will experience skin rash, sweating, ringing in the ears, shakiness, stomach pain, muscle pain, thought disturbances, anxiety or angle closure glaucoma (symptoms of angle closure glaucoma may include eye pain, changes in vision, swelling or redness in or around eye).

Unlike many antidepressants, bupropion does not commonly cause sexual side effects and may be selected as an alternative treatment when antidepressant-induced sexual side effects are problematic. Sexual side effects include such problems as difficulty achieving orgasm or ejaculatory delay.

In general the risk of seizures due to bupropion is low. The risk of having a seizure increases with higher than recommended doses of bupropion, a history of seizures or head injury, tumor in the brain, severe liver disease, an eating disorder, alcohol or drug dependence, or taking other drugs that can also increase your risk of having a seizure.

There is a low risk of cardiovascular adverse events associated with stimulating agents, including bupropion. This risk increases if you have heart disease, high blood pressure, previous heart attack, or irregular heartbeat, or when used with transdermal nicotine replacement products. In these cases, a thorough cardiovascular evaluation is recommended before starting this medicine.

Are There Any Risks For Taking Bupropion 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 Bupropion?

Bupropion should not be taken with or within two weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranycypromine (Parnate®), isocarboxazid (Marplan®), and selegiline (Emsam®).

There are several products with the active ingredient bupropion. Do not take more than one product that contains bupropion since this may increase your risk of having a seizure.

Certain medications may increase your risk of having a seizure when combined with bupropion. These include other antidepressants, antipsychotics, theophylline, isoniazid, tramadol, stimulants, steroids, hypoglycemic agents (including insulin), certain antibiotics (e.g., Cipro®), and abrupt discontinuation of benzodiazepines (e. g., Ativan®).

Notify your doctor and pharmacist if you are taking any of the following medications: phenytoin (Dilantin®), carbamazepine (Tegretol®, Equetro®), phenobarbital, cimetidine (Tagamet®), ritonavir (Norvir®), lopinavir (Kaletra™), nelfinavir (Viracept®), or efavirenz (Sustiva®). These medications can change the way your body reacts to bupropion.

Notify your doctor and pharmacist if you are taking any of the following medications: atomoxetine (Stratterra®), codeine, tamoxifen, tetrabenazine, thioridazine (Mellaril®), tramadol (Ultram®), or a tricyclic antidepressant. Bupropion can change the way your body reacts to these medications.

How Long Does It Take For Bupropion 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.

Summary of FDA Black Box Warnings

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 ages 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.

Provided by

(December 2020)

©2020 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.

This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

Memorial Sloan Kettering Cancer Center

Adult Medication

Provided by Lexicomp ^® , this document contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Aplenzin; Forfivo XL; Wellbutrin SR; Wellbutrin XL; Zyban [DSC]

Trade names: Canada

MYLAN-BuPROPion XL [DSC]; ODAN Bupropion SR; TARO-Bupropion XL; TEVA-Bupropion XL; Wellbutrin SR; Wellbutrin XL; Zyban

Warning

Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people. This risk may be higher in people who have tried or had suicidal thoughts in the past. All people taking this drug must be closely monitored. If you develop or worsen disorders such as depression, nervousness, anxiety, grouchiness, panic attacks, and changes in mood or behavior, contact your doctor immediately. Contact your doctor immediately if you have suicidal thoughts or suicide attempts.

What is this drug used for?

Used to treat depression.
Used to prevent seasonal affective disorder (SAD).
Used for smoking cessation.
This drug may be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

If you have an allergy to this drug, any of its ingredients, other drugs, foods, or substances. Tell your doctor about your allergies and how they have manifested.
If you have ever had a seizure.
If you abuse alcohol and stop drinking it abruptly.
If you are taking certain other drugs, such as anticonvulsants or tranquilizers, and you stop taking them abruptly.
If you have ever had an eating disorder such as anorexia or bulimia.
If you have any of the following health conditions: kidney disease or liver disease.
If you have taken medicines for depression or Parkinson's disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
If you are taking any of the following: linezolid or methylene blue.
If you are taking another drug that contains the same drug.

This list of drugs and conditions that may interact with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor's advice.

What do I need to know or do while taking this drug?

For all patients taking this drug:

Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
Avoid driving or doing other tasks or jobs that require alertness or keen eyesight until you know how this drug affects you.
This drug may affect the results of some lab tests. Tell all your health care workers and laboratory staff that you are taking this drug.
Do not stop this drug abruptly without talking to your doctor. This can increase the risk of side effects. If necessary, taking this drug should be stopped gradually, in accordance with the recommendations of the doctor.
High blood pressure has happened with this drug. Monitor your blood pressure as directed by your doctor.
This drug may increase the risk of seizures. The risk may be increased in people who take higher doses of the drug, who have certain health problems, or who use certain other drugs. People who abruptly stop drinking large amounts of alcohol or abruptly stop taking certain medications (such as drugs used for anxiety, insomnia, or seizures) are also at higher risk. Talk to your doctor to find out if you have an increased risk of seizures.
Avoid drinking alcohol while taking this drug.
Talk to your doctor before using marijuana, other forms of cannabis, or prescription or over-the-counter drugs that can slow you down.
It may take several weeks to achieve full effect.
This drug is not approved for use in children. Consult your doctor.
If you are 65 years of age or older, use this drug with caution. You may experience more side effects.
Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. The benefits and risks for you and your child will need to be discussed.

If you smoke:

Not all drugs are approved to help you stop smoking. Check with your doctor to make sure you get the right drug.
When using bupropion for smoking cessation, the emergence of new or aggravation of existing disorders of the psyche, mood or behavior was noted. These disturbances include suicidal or homicidal thoughts, depression, violent acts, rage, anxiety and anger. These disorders have been observed in people with and without mental and mood disorders in the past. Consult your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor right away or get medical help if you have any of the following signs or symptoms that may be associated with serious side effects:

Signs of an allergic reaction such as rash, hives, itching, red and swollen skin with blisters or flaking, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
Signs of high blood pressure such as very severe headache or dizziness or loss of consciousness or blurred vision.
Feeling of confusion, inability to concentrate or changes in behavior.
Hallucinations (a person sees or hears something that is not in reality).
If, after starting the medicine, convulsions become more frequent or more severe.
Chest pain, angina pectoris, tachycardia or abnormal heart rhythm.
Inflammation.
Shortness of breath.
Change in hearing.
Ringing in the ears.
Frequent urination.
Gland swelling.
Violation of motor functions.
There may be an increased risk of eye problems when using this drug in some patients. Your doctor may order an eye examination to see if you are at increased risk for these eye problems. Call your doctor right away if you have eye pain, vision changes, swelling or redness around the eye.
Possible severe skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis). This can lead to severe health problems, which can be permanent, and sometimes death. Seek immediate medical attention if you experience symptoms such as redness, swelling of the skin with blistering or peeling (with or without fever), redness or irritation of the eyes, and sores in the mouth, throat, nose, or eyes.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if these or any other side effects bother you or do not go away:

All formulations:

Dizziness or headache.
Constipation, diarrhoea, abdominal pain, nausea, vomiting or loss of appetite.
Trembling.
Nervous tension and agitation.
Strange or unusual dreams.
Gas formation.
Dry mouth.
Sleep disorders.
Pain in joints or muscles.
Irritation of the nose or throat.
Excessive sweating.
Unexplained fluctuations in weight.

Extended release tablets:

The tablet shell of certain brands of drugs can sometimes be seen in the stool. For drugs of these brands, this is normal and does not cause concern. If you have any questions, please consult your doctor.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

For all uses of this drug:

Do not take more often than directed. This may increase your risk of developing seizures. Make sure you know at what intervals you need to use the drug.
Take in the morning if you are taking this drug once a day.
Take this drug with or without food.
If you cannot sleep, do not take this drug at bedtime. Consult your doctor.
Swallow whole. Do not chew, break or crush.
Keep taking this drug as your doctor or other health care professional tells you to, even if you feel well.
If you have difficulty swallowing, talk to your doctor.

Smoking cessation:

You can take this drug for 1 week before you stop smoking.
Nicotine replacement and psychological help can be done at the same time for best results.
If you have not been able to stop smoking after 12 weeks of taking this drug, talk with your doctor.
When you try to quit smoking, you may experience nicotine withdrawal symptoms even if you use quit smoking drugs like this drug. There are many signs of nicotine withdrawal. People who are trying to quit smoking have occasionally experienced depression and suicidal thoughts. Consult with your physician.

What if I miss a dose of a drug?

Skip the forgotten dose and return to your regular schedule.
Do not take 2 doses or an additional dose at the same time.

How do I store and/or discard this drug?

Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about drugs

If your health does not improve or even worsens, call your doctor.
Do not give your medicine to anyone or take other people's medicine.
Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
A separate patient leaflet is included with this product. Please read this information carefully. Reread it each time you refill your supply. If you have any questions about this drug, ask your doctor, pharmacist, or other health care professional.
If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient's specific and unique circumstances. Patients should consult with their physician for full information about their health, medical issues, and treatment options, including any risks or benefits regarding the use of medications. This information is not a guarantee that a treatment or drug is safe, effective, or approved for a particular patient. UpToDate, Inc. and its subsidiaries disclaim any warranties or liabilities related to this information or its use. The use of this information is subject to the Terms of Use found at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.

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Date last updated

Wednesday, December 7, 2022

SIDE EFFECTS OF ANTIDEPRESSANTS (SSRIs) | Clinical Center "Psychiatry - Narcology"

Currently, the most commonly prescribed antidepressants are drugs from the group of selective serotonin reuptake inhibitors (SSRIs). For most, these medicines are safe and effective, but like all medicines, they can cause side effects. According to statistics, about 40% of patients taking antidepressants also experience side effects, in about 25% of cases they are quite unpleasant. Two of the most common side effects (sexual dysfunction and weight gain) are often the reason people stop taking these medications.

Listed below are the 7 most common side effects of antidepressants that patients should be aware of:

1. SOMATIC SYMPTOMS.

When medications are first prescribed to treat depression, the most common physical symptoms are headache, nausea, joint and muscle pain, rash, and diarrhea. These symptoms are usually mild and temporary. The results of clinical studies have shown that nausea and headache are the most common. As a rule, these symptoms are adaptive in nature, as a rule, they pass on their own, without requiring discontinuation of the drug.

2. SLEEP DISTURBANCE.

Many patients, when first prescribed antidepressants, report problems with sleep: difficulty falling asleep or light sleep with frequent awakenings. Also, against the background of taking SSRIs, nightmares and sleepwalking can be observed. Studies have shown that about 22% of people taking antidepressants experience sleep problems.

3. DAY SLEEPNESS .

Sleepiness during the day may be the result of a poor night's sleep, or the direct sedative effect of the antidepressant. In the case when it is a sedative effect, the problem can be solved by transferring the drug to the evening.

4. MIGRAINES

Due to the fact that people who are prone to depression also often suffer from migraines, you need to be careful when taking medications in combination. Medicines; used to treat migraines, triptans, like SSRIs, increase serotonin levels in the brain. If these drugs are used together, it can lead to the development of serotonin syndrome, which manifests itself in the form of headache, heart palpitations, hot flashes. Be sure to discuss with your doctor how to avoid the development of serotonin syndrome if you are prescribed medications of both groups.

5. WEIGHT SET.

Weight gain is one of the late side effects of antidepressants and is one of the most common reasons for refusing to continue taking or changing the drug. A good prevention of this side effect is moderate physical activity (for example, a 30-minute workout every other day). The likelihood of weight gain also depends on the drug that is prescribed. According to clinical trials, while taking paroxetine, about 25% of patients gain 7% of their weight.

6. SUICIDE .

The risk of suicide while taking antidepressants is currently under extensive investigation. According to most studies, compared with placebo, taking SSRIs or other antidepressants doubles the likelihood of suicidal thoughts. The overall risk of this side effect when taking antidepressants in adolescents and adults is 2 to 4 percent. One of the reasons for suicide while taking antidepressants is that medications increase activity, giving energy for the implementation of a suicidal plan. Regular follow-up by a doctor can reduce the risk of this side effect.

7. SEXUAL DYSFUNCTION.

Sexual dysfunction is one of the most common long-term side effects of SSRIs. These include decreased sexual desire, delayed ejaculation in men, and inability to achieve orgasm in women. Up to 60% of people taking SSRIs experience one of these side effects. And these are the side effects that patients are not ready to endure.

If you are concerned about any side effects, discuss them with your doctor. As a rule, you can find a solution for any of them. It is not recommended to stop taking medications on your own.

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