Wellbutrin (Bupropion): Indications, Side Effects, Interactions, Overdose, and Withdrawal

What is bupropion and what is it used for?

Bupropion is a medication most commonly prescribed to treat depression and to help quit smoking. It can also be used to treat ADHD, bipolar depression, and seasonal affective disorder. A bupropion/naltrexone combination may help with weight loss. Common brand names of bupropion include Wellbutrin^®, Zyban^®, and Contrave^®. Bupropion works in the brain by increasing the amount of norepinephrine and dopamine, which are brain chemicals that can help regulate a patient’s mood and stress responses. It is available in immediate release (IR), sustained release (SR), and extended release (XL) formulations.

Is Wellbutrin an SSRI?

No, Wellbutrin (bupropion) is not an SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin norepinephrine reuptake inhibitor). It is structurally different than other antidepressant agents including tricyclic antidepressants and SSRI's. Bupropion is a type of drug known as an NDRI (norepinephrine and dopamine reuptake inhibitor), but its exact mechanism of action is unknown.

What are bupropion’s side effects?

Patients taking bupropion may experience restlessness, agitation, dizziness, constipation, a fast heart rate, and trouble sleeping, especially when they first start the medication. Patients may also experience weight loss, sweating, and tremors. However, these symptoms often resolve after taking the medication for a few weeks. Less than 10% of patients may also experience high blood pressure, itchiness, rash, abnormal dreams, and muscle aches.

There are a few serious side effects of bupropion. Seizures happen in less than 1% of people and are associated with high doses of bupropion. People who have a history of seizures or risk factors for seizures should use bupropion with extreme caution. New or worsening suicidal thinking and behavior may also be seen. It is important for family and friends to watch for suicidal thinking, especially in the first few weeks after starting bupropion. There is also a risk of neuropsychiatric events, including depression, hallucinations, and aggression.

One benefit of bupropion is that it doesn’t have as many sexual side effects. Other antidepressants, such as citalopram and fluoxetine, can cause some patients to have reduced sexual desire or satisfaction. This is a major cause of people discontinuing their depression medications. But bupropion appears to affect libido less, which can make it a good alternative for some patients.

Bupropion and Alcohol – do they mix?

It is not recommended to take bupropion and drink alcohol at the same time. When bupropion and alcohol are consumed together, there is a risk of more severe symptoms, such as seizures. Ideally, avoid alcohol while you are taking bupropion. However, if you usually drink a lot of alcohol, speak with your doctor before stopping abruptly. Abrupt discontinuation of alcohol can also increase your risk of seizures.

Bupropion interactions: what foods or medicines should I avoid while taking Wellbutrin or Contrave?

Certain antidepressants (MAOIs, SSRIs), antipsychotics (haloperidol, risperidone), and heart medications (beta blockers, antiarrhythmics) can interact with bupropion. Speak with your pharmacist or doctor to make sure the medications you take do not interact with bupropion.

For Contrave specifically, you should not take any opioid pain medications, such as morphine or oxycodone. One of the components of Contrave will block the pain medication, meaning you will not have your normal pain relief. It is also recommended to not take Contrave with high-fat meals. When taken together, fatty foods cause more Contrave to be absorbed, which may lead to more Contrave in your body than you want or expect.

Can I take Wellbutrin during pregnancy?

Current studies suggest that bupropion is safe in pregnancy, as it has not been linked to any harm for newborns. In general, there are very few trials done on safety in pregnancy because of the ethics of testing on expectant mothers. Because of this, it’s often hard to find evidence of how safe medications are while a person is pregnant. Often, scientists monitor pregnant patients who have decided to continue to take medications to see if there are any concerns for the baby.

Ultimately, the decision to start or stop a medication would be up to the parents and doctor. The risk of untreated depression or smoking is often more demonstrably harmful to the baby than the medication could potentially be. Speak with your doctor to see if they can help you decide what is best for you and your child.

The National Pregnancy Registry for Antidepressants (NPRAD) is dedicated to evaluating the safety of antidepressant medications that are taken during pregnancy. If you have decided to continue with bupropion during pregnancy, it is encouraged to participate in this study to help scientists and doctors grow the safety information available.

What are the symptoms of Wellbutrin overdose?

Overdose happens when you take too many bupropion tablets at once. There are many signs of an overdose, such as losing consciousness, fever, hallucinations, and muscle pain. One of the biggest concerns is seizures, which can happen in 1/3 of all bupropion overdose situations. If someone might have overdosed on bupropion, go to a hospital immediately. People who overdose on bupropion are also at risk for heart problems and the loss of the ability to breathe on their own.

How quickly will it take to work?

After starting bupropion, symptoms of depression will typically gradually decrease over a period of a few weeks. It often takes a few weeks before you start feeling the full effects, so it is very important to be patient in this timeframe. Make sure to take bupropion exactly as prescribed and let your doctor know if it doesn’t seem to be working for you after a few weeks.

What to do if someone takes too much or has an adverse reaction to bupropion

If someone takes too much or experiences worrisome side effects from taking bupropion, get guidance from Poison Control immediately. Help from Poison Control is available online at www.poison.org and by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day.

Wellbutrin and Zyban are registered trademarks of GlaxoSmithKline LLC.

Contrave is a registered trademark of Orexigen Therapeutics, Inc.

Pamela Gonzales, BS, PharmD 2023 Candidate
Student Pharmacist, Pharmacy Intern