Other names: Wellbutrin SR

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Bupropion under the brand name Wellbutrin is commonly prescribed to treat major depression and, under the brand name Zyban to help individuals quit smoking. Bupropion increases levels of the neurotransmitters dopamine and norepinephrine, working differently than other antidepressants. It is unclear how it works to help people quit smoking. It may be a more suitable treatment for depression than tricyclic antidepressants if those medications cause significant weight gain in a patient.

Wellbutrin has also been found to be effective for the following conditions:

• Reduce symptoms of chronic fatigue syndrome.
• Alternative to stimulants in treating attention deficit hyperactivity disorder (ADHD) for children and adults.
• Treats post-traumatic stress disorder.
• Works to help people quit smokeless tobacco.
• May increase sexual desire.
• May be a useful part of treatment for cocaine addiction when used along with counseling, as it may reduce cravings.
• Can reduce lower back pain that is unresponsive to other therapies.

Wellbutrin and Zyban are only available by prescription. Use only as directed, and only in combination with over the counter or prescription medications that your doctor or pharmacist say are safe.

Wellbutrin | Zyban Side Effects

Common bupropion side effects: Anxiety, confusion, insomnia, nervousness, or weight loss (individuals who are underweight may want to consider another treatment, as their weight may drop further on this medication).

Possible bupropion side effects: Agitation, constipation, dizziness, dry mouth, frequent urination, heart palpitations, indigestion, nausea or vomiting, ringing in the ears, severe headaches, sweating, swelling, tremor. Consult your physician as soon as possible if any of these conditions develop. While not all of them are serious, your doctor should make that determination, and may be able to help alleviate temporary discomfort.

Rare bupropion side effects: Altered white blood cell or platelet counts, liver poisoning, mania in patients with manic depression, psychosis in patients with psychotic tendencies, or drug-related seizures (increased likelihood with higher doses). Seek medical attention immediately if any of these effects occur. If you have had a medical history of any of these conditions, your doctor should monitor your treatment closely or may decide on a different medication. In very rare cases, weight gain has been reported with treatment, though weight loss is far more common. Speak to your doctor if this occurs.

Cautions: Before taking Wellbutrin or Zyban, inform your doctor of any of the following conditions, or a history of them. Some of these conditions are contraindications for treatment, and you should try another medication. Some conditions may require more careful monitoring, or dosage adjustments.

• Alcoholism or drug abuse: Bupropion does not react well with alcohol or street drugs. You could be at increased risk for seizure, psychosis, or a fatal drug interaction.
• Allergies: If you have had an allergic reaction to Wellbutrin or Zyban in the past, this medication is not right for you. If you experience any swelling of the face or extremities, or break out in a rash, contact your doctor immediately. Also be sure to inform your doctor of any other allergies you may have had, either to prescription medication, or food and dyes.
• Brain disease, mental illness, or head injury: A doctor must consider treatment carefully, on a case by case basis.
• Eating disorder: If you have, or had in the past, either anorexia nervosa or bulimia, you may be at an increased risk for seizure. Also, underweight individuals may find that their weight drops further with bupropion treatment, and this could be dangerous for some people. Consult with your doctor about possible risks.
• Heart problems: If you have heart disease or have had a recent heart attack, your doctor may be very cautious in prescribing treatment. Also, bupropion may interact with certain prescription treatments for heart disease or high blood pressure.
• Kidney or liver problems: Your doctor may adjust your dosage and monitor you more carefully.
• Other medicines: Inform your doctor of any medications you are currently taking, especially if they increase the likelihood of seizure. Discuss any reactions to medication you have had in the past, especially to other antidepressants. Do not take bupropion within 14 days of stopping an MAO inhibitor.
• Pregnancy or an intention to become pregnant may indicate that you should not take Wellbutrin or Zyban. Doctors do not generally recommend taking bupropion while breastfeeding.
• Seizure disorders: Individuals with seizure disorders of any kind should not take bupropion either as Wellbutrin or Zyban, for any reason. This medication increases the risk of seizure.

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If you are planning to take bupropion as Wellbutrin or Zyban, be sure that the prescribing physician is aware of all other medications you are using, especially if you see multiple doctors. Some medications should not be mixed with bupropion at all, and with others, your doctor may want to adjust the dosage of one or the other prescription. Ask your doctor before starting any medication while you are being treated with bupropion.

Wellbutrin and Zyban should not be taken together, as higher doses of bupropion increase the risk of serious side effects, such as seizures.

• Alcohol can increase the risk of seizure in combination with bupropion. Do not drink while you are being treated with this medication, it is not safe.
• Ambien (zolpidem) may increase the risk of hallucination.
• Anticonvulsants such as Dilantin (phenytoin) or Cerebyx (fosphenytoin) may be less effective when taken with Wellbutrin or Zyban.
• Barbiturates such as Phenobarbitol may lower levels of bupropion in the body.
• Beta Blockers (blood pressure, heart disease, migraine prevention medication) such as Inderal (propranolol), Lopressor (metoprolol), or Tenormin (atenolol) should be taken with care during bupropion treatment
• Bronchodilators of the xanthine (thioxanthine) class (Aminophylline, Dyphylline, Oxtriphylline, Somophyllin, Theo-Dur, etc...) may increase your risk of seizure.
• Clozaril (clozapine) may increase the risk of seizure from Wellbutrin or Zyban.
• Cytoxan (cyclophosphamide)
• Desyrel (trazodone)may increase the risk of seizure.
• Ginseng - Do not take this herb while using bupropion in any form.
• Haldol (haloperidol) may increase the risk of seizure from Wellbutrin or Zyban.
• Lithium may increase the risk of seizure from Wellbutrin or Zyban.
• Loxitane (loxapine) may increase the risk of seizure from Wellbutrin or Zyban.
• Ludiomil (maprotiline) may increase the risk of seizure from Wellbutrin or Zyban.
• Ma Huang - Do not take this herb while using bupropion in any form.
• MAO inhibitors - Wellbutrin and Zyban should not be mixed with MAO (monoamine oxidase) inhibitors, a class of antidepressants and antisenility drugs, such as Eldepryl (selegiline), Furoxone (furazolidone), Nardil (phenelzine), Marplan (isocarboxazid), or Parnate (tranylcypromine). Wait 2 weeks after stopping an MAO inhibitor before taking bupropion, this drug reaction could be very dangerous.
• Marijuana - There is a risk of psychotic behavior if marijuana usage is combined with Wellbutrin or Zyban treatment. Avoid this combination.
• Moban (molindone) may increase the risk of seizure from Wellbutrin or Zyban.
• Nicotine gum or patches - If you plan to use nicotine replacement in addition to Zyban while you are trying to quit smoking, consult your doctor about the best plan of action. Combining these two treatments may not work for you.
• Norgesic/Norflex (orphenadrine)
• Protease inhibitors such as Norvir (ritonavir) may lead to toxic levels of bupropion in the body. This drug combination is dangerous, and these treatments should not be used at the same time.
• Provigil (modafinil) - May increase CNS stimulation.
• Risperdal (risperdone) may build up to toxic levels in the body if taken with bupropion.
• Ritalin (methylphenidate)
• Rythmol (propafenone) should be taken in lower doses, as it may build up to toxic levels in the body if taken with bupropion.
• Selective serotonin reuptake inhibitors (SSRIs) like Celexa (citalopram), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline) may increase the risk of seizure from Wellbutrin or Zyban.
• Sinemet (carbidopa, levodopa) - Increases risk of side effects.
• St. John's Wort - Do not take this herb while using bupropion in any form.
• Steroids like Prednisone or Hydrocortisone - Consult your doctor before combining treatment.
• Stimulants and certain prescription diet pills may increase the risk of seizure with bupropion, this combination is not advised. Consult your doctor about the safety of any stimulant medication while you are being treated with Wellbutrin or Zyban.
• Tagamet (cimetidene) may raise levels of bupropion.
• Tambocor (flecainide) - Bupropion may increase levels of this medication, and it is recommended that your doctor lower your Tambocor dosage to avoid toxicity.
• Tegretol (carbamazepine) - Bupropion may lower levels of this medication.
• Tranquilizers and antipsychotics of the phenothiazine class, such as Mellaril (thioridazine), Trilafon (perphenazine), and Thorazine (chlorpromazine) may increase the risk of seizure from Wellbutrin or Zyban.
• Tricyclic antidepressants such as Elavil (amitriptyline), Asendin (amoxapine), Anafranil (clomipramine), Pertofrane or Norpramin (desipramine), Sinequan (doxepin), Tofranil (imipramine), Aventyl or Pamelor (nortriptyline), Vivactil (protriptyline), and Surmontil (trimipramine), may increase the risk of seizure from Wellbutrin or Zyban.
• Yohimbe - Do not take this herb while using bupropion in any form.

A common starting dose of Wellbutrin for depression is 100 mg in the morning and again in the evening. This may be increased after four days by adding a 100 mg dose at midday, for a total daily dose of 300 mg. Doses should be no closer than 6 hours, and may be increased above 300 mg after three or four weeks to a maximum of 450 mg per day in divided doses of 150 mg each. For attention-deficit hyperactivity disorder (ADHD) in adults, 100-200 mg of the sustained release form two times per day is recommended.

Zyban is commonly started with 150 mg once a day, for three days. After this, it may be increased to 150 mg twice per day for up to 12 weeks. You should have made progress with stopping your smoking habit by 7 weeks, or your doctor should reevaluate your treatment.

Bupropion dosage should never exceed a total of 450 mg per day, as this would greatly increase the risk of seizure. Never take double doses of this medication, or take it more often than your doctor has suggested. Only a doctor with access to your full medical history can determine if Wellbutrin or Zyban are safe treatments for you. Never allow anyone else to use your prescription, as this could be very dangerous.

Wellbutrin

• Immediate release tablets - 75 mg, 100 mg
• Sustained release tablets - 100 mg, 150 mg

Zyban

• Sustained release - 150 mg

Wellbutrin tablets are best taken whole, as the medication is bitter. Zyban tablets, and sustained release Wellbutrin tablets, should never be crushed or broken as it could result in a dangerously high dosage of bupropion. The tablets may be taken with food or milk to reduce stomach upset, there are no restrictions on taking bupropion with food.

If you miss a dose: For regular Wellbutrin tablets, take it as soon as you remember, unless it is close to the time for your next dose. If it is almost time for the next tablet, skip the missed dose. If you are taking Zyban or sustained release Wellbutrin, simply wait until the next day and resume your regular schedule, ignoring missed doses. Never take double doses of bupropion, or take doses too close together, as it increases the risk of seizure. Dosage should never exceed 450 mg per day, or be taken closer together than your doctor suggests is safe.

If you are using Zyban to quit smoking: Begin treatment at least a week before you plan to quit, and set a specific date in the second week of treatment. Plan a support program with the help of your doctor, as this will greatly increase the likelihood of success.

Store bupropion away from direct light and heat. Store in a dry location; avoid storing it in the bathroom, near sinks, or other areas where it may become damp. Do not use after the expiration date.

Keep bupropion away from children; both when storing it, and when discarding any unused medication.

Bupropion may cause drowsiness, disorientation, or seizure. Be cautious if you plan to drive or operate heavy machinery, avoid these activities if you find yourself feeling tired or experience slowed reactions.

Wellbutrin | Zyban and Pregnancy

Wellbutrin has not been tested for safety in pregnant women, though it does not seem to increase the risk of birth defects in animal studies. Consult your doctor if you are, or plan to become pregnant while taking Wellbutrin or Zyban. This medication may pass into breast milk, and cause unwanted side effects in a nursing child. Your doctor may recommend that you not breastfeed while taking Wellbutrin.

Consult with your doctor if you are a smoker and plan to become pregnant, as it may be beneficial to take a course of Zyban before your pregnancy. Smoking poses serious known risks to an unborn child, and Zyban may work for you within 7-12 weeks.

Wellbutrin | Zyban and Children

Dosage has not been established for individuals under 18. Your doctor will have to determine dosage individually, taking the child's age and weight into account.

Wellbutrin | Zyban and Seniors

No special precautions or recommendations appear to be necessary for individuals over 60 years of age.

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Wellbutrin and Zyban are trademarks of Glaxo Wellcome

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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.

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