Wellbutrin (Bupropion): Side Effects and Interactions

What is bupropion, and what is it used for?

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

How quickly will it take effect?

After starting bupropion, symptoms of depression will typically gradually decrease over time. It often takes a few weeks before you start feeling the full effects, so it is very important to be patient during this time. 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.

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 from other antidepressant drugs, including tricyclic antidepressants. Bupropion is an NDRI (norepinephrine and dopamine reuptake inhibitor), but its exact mechanism of action is not fully understood.

What are bupropion’s side effects?

Patients taking bupropion can experience restlessness, agitation, dizziness, constipation, a fast heart rate, and trouble sleeping, especially when they start the medication. Patients might 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 experience high blood pressure, itchiness, rash, abnormal dreams, or muscle aches.

Seizures happen in less than 1% of people taking bupropion and are associated with high doses. 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 might also occur. 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 does not have a lot of 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 reason why patients discontinue antidepressant medications. But bupropion appears to affect libido less, which can make it a good alternative.

Bupropion and alcohol—do they mix? 

When bupropion and alcohol are consumed together, there is a risk of more severe adverse effects, including seizures. 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 (quitting "cold turkey") can 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 and doctor to make sure the other medications you take do not interact with bupropion.
One of the components of Contrave blocks the action of opioid pain medication such as morphine or oxycodone, meaning you will not have your normal pain relief. Contrave should not be taken with a high-fat meal. Fatty foods cause more Contrave to be absorbed, which can lead to more Contrave in your body than you want or expect.

What are the symptoms of Wellbutrin overdose?

An overdose happens when you take too much bupropion at once. Signs of an overdose include loss of consciousness, fever, hallucinations, and muscle pain. One of the biggest concerns is seizures, which happen in about a third of bupropion overdoses. If someone might have overdosed on bupropion, take them to a hospital immediately. People who overdose on bupropion are also at risk for heart problems and the loss of their ability to breathe on their own.

Can I take Wellbutrin during pregnancy?

Bupropion has not been linked to any harm to a developing fetus. However, there are very few trials done on drug safety in pregnancy because of the ethics of testing on expectant mothers. Because of this, it is often hard to find evidence of how safe medications are while a woman is pregnant. Scientists sometimes monitor pregnant women 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 is up to the woman and her doctor. The risk of untreated depression or smoking might be more harmful to the baby than the medication. Speak with your doctor to 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 decide to continue with bupropion during pregnancy, you should consider participating in this study to help scientists and doctors increase the usefulness of bupropion’s safety information.

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 and by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day.

Pamela Gonzales, BS, PharmD
Student Pharmacist, Pharmacy Intern