Buproprion (Wellbutrin, Zyban, Budepron, Buproban)
Buproprion is an atypical antidepressant classified as a monocyclic aminoketone. It received FDA approval in 1984 for the treatment of depression. In 1986, buproprion was removed from the market due to an unacceptable incidence of seizures in people who took it. It was reintroduced in 1989 with a lower dosing schedule.
The Bottom Line: What You Really Need to Know
- Buproprion (Trade Names: Welbutrin, Zyban) is usually used to treat depression, including bipolar disorder, and nicotine addiction. In the UK, it is only approved for the treatment of nicotine addiction. It may have other uses.
- The usual starting dose is 75-150 mg daily, increasing to 300-450 mg daily.
- Buproprion is usually taken in the morning to avoid insomnia.
- Buproprion interacts with many medications. Make sure your doctor and pharmacist know about all of the medications you take, including over-the-counter medications, herbal remedies, homeopathic remedies, vitamins, supplements and medications you only take occasionally.
- It will probably be up to four weeks before you notice any difference in the way you feel.
- Don't stop taking buproprion suddenly; the dose must be tapered gradually or you may experience withdrawal symptoms.
- Most people have a few mild side effects, like dry mouth, nausea or insomnia, when they start taking buproprion. They usually go away with time.
- Buproprion is not associated with sexual side effects like most antidepressants are.
- There is an increased risk of seizures with buproprion. People who already have risk factors for seizures should not take this medicaton.
- Have a friend or family member check in with you every day for the first few weeks you take buproprion. Ask him or her to help monitor your condition for
- Worsening depression
- Restlessness, irritability, agitation, hostility or aggression
- Unusual thoughts or thoughts of suicide
- Report any serious or unusual side effects to your doctor.
- Women who are trying to get pregnant or are pregnant or nursing should not take buproprion.
- Children under the age of 18 should not take buproprion.
- Buproprion can give false positive results for amphetamines in drug tests. If you take a drug test, make sure you note that you take buproprion.
How buproprion is used
Buproprion is used primarily as an antidepressant in the United States. Its antidepressant activity is similar to other medications, it has fewer sexual side effects and it is not associated with weight gain. It also improves fatigue and sleepiness.
Buproprion can be used to augment SSRI antidepressants and it can be used without mood stabilizers to treat bipolar disease.
Buproprion (Zyban) is approved to treat nicotine addiction in the United States and the United Kingdom. (That is the only indication buproprion is approved for in the UK.)
It is also used "off label" to treat the following conditions (Medications may be used "off label" for conditions they are not approved for.):
- Sexual dysfunction related to SSRI use-can either change to buproprion or add it as a second medication
- Sexual dysfunction in the absence of antidepressant use. (Buproprion does not augment sexual function in healthy males.)
- ADHD in children or adults
- Seasonal Affective Disorder
- Weight loss
- Low back pain
- Cocaine craving
- Possibly methamphetamine addiction
Dosage and instructions
You usually start buproprion at a low dose of 75-150 mg/day for a few days. The dose can be increased to 300 mg, and then to 450 mg/day if necessary. The maximum recommended dose is 450 mg/day. It can take 4 weeks or more to achieve the full therapeutic effect. Buproprion should be taken in the morning to prevent sleeplessness.
How buproprion works
Buproprion inhibits the reuptake of norepinephrine and dopamine from the junction of nerve cells. It is a nicotine antagonist and has a stimulating effect on the brain.
Side effects
Buproprion can cause a number of side effects, including:
- Dry mouth
- Nausea, upset stomach, constipation
- Insomnia
- Sweating
- Ringing in the ears
- Rashes
- High blood pressure
- Excitement, anxiety, confusion
- Dizziness, headache
- Weight loss
- Confusion, hallucinations, paranoia
- Fever
- Swelling
- Muscle and joint pain
- Palpitations
- Tremors or seizures
Interactions
There should be at least a two week time lapse between taking buproprion and monamine oxidase inhibitors (MAOIs). MAOIs can increase buproprion levels and cause toxicity.
The following medications increase the likelihood of having seizures when you are taking buproprion, and they should be avoided:
- Tricyclic antidepressants
- Carbamazepine (Tegretol)
- Cimetadine (Tagamet)
- Clozapine (Clozaril)
- Fluoxetin (Prozac)
- Haloperidol (Haldol)
- Levodopa
- Lithium
- Loxapine (Loxapac)
- Molindone (Moban)
- Phenothiazine medications (Thorazine, Stellazine, etc)
- Thioxanthines (antipsychotic medications)
- Trazadone (Deseryl)
Withdrawal
Buproprion should not be withdrawn suddenly; the dose must be tapered over several days or weeks.
Precautions, warnings and contraindications
Suicide risk: All antidepressants increase the risk of suicide, especially when you first begin taking them. During the first several weeks or months of buproprion treatment, you should be monitored closely by your physician or therapist and by family and friends. Any increase in depression, mood swings, unusual thoughts or behaviors, agitation, aggression or thoughts of harming yourself or others must be reported to the physician immediately.
MAOI: There must be a two week delay between taking monoamine oxidase antidepressants and buproprion.
Liver disease: Buproprion should be used with caution and at a reduced dose in people with liver disease. Rare instances of liver toxicity have occurred with buproprion.
Kidney disease: Use with caution and at decreased dose with kidney disease (buproprion is excreted by the kidneys).
Seizures: Buproprion is a central nervous system stimulant. There is an increased risk of seizures in people who are already susceptible to them. Buproprion should not be taken by people who have:
- Alcoholism
- Anorexia or bulimia
- Brain tumors
- Seizure disorders
Buproprion should not be taken by women who are pregnant, who wish to become pregnant or who are breast feeding.
Buproprion should not be used by children under age 18.
Additional information
Buproprion can cause a false positive reading for amphetamines on drug tests.
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