Wellbutrin XL, Bupropion

Wellbutrin® (bupropion) is an antidepressant medication. It works in the brain to treat depression. Wellbutrin® is used to treat major depressive disorder and seasonal affective disorder. At least one brand of bupropion (Zyban) is used to help people quit smoking without cravings and other withdrawals.

Introduction to Wellbutrin XL

Bupropion regulates the amount of noradrenaline (norepinephrine) and dopamine in the brain. These naturally occurring substances play a role in emotions and moods.

Doctors prescribe it for smoking addiction, depression, and ADHD.

Trade Information

Bupropion has been internationally available since 1985. It is available by prescription under the brand names Wellbutrin and Zyban in extended-release tablets.

How should I use Wellbutrin XL?

Check the pharmacy label for the correct dosage.

How?
Swallow the tablets whole. Do not chew or crush the tablets, as they would then release the bupropion immediately. They are designed to release the active ingredient slowly, so they work longer.

When?

• If you are taking the medicine once a day, it is best to take it in the morning. This minimizes the side effect of insomnia.
• If you are taking the medicine twice a day, take it in the morning and at the end of the afternoon. This minimizes the side effect of insomnia. Please make sure there is at least 8 hours between doses.

How long?

• Smoking addiction: You do not need to stop smoking in the first week you take this medicine. Stop smoking in the second week of treatment. Usually, the doctor prescribes this medicine for up to nine weeks. If after seven weeks of using bupropion you are still smoking (the same amount), further treatment with this medicine is pointless.
• Depression: if the medicine has no effect after six weeks of use, discuss with your doctor. After improvement of symptoms, you should usually continue using it for six months or longer to decrease the chance of depression returning.
• ADHD: after a few weeks, you and your doctor can usually evaluate if the treatment is effective. How long you need to use this medicine varies. Usually, you need to use this medicine for a long time.

Discuss any changes in your behavior or mood with your doctor throughout the treatment. It may be that you are not responding well or sufficiently to this medicine and might find more benefit in another medicine.

What side effects should I be aware of?

Besides the desired effect, this medicine can cause side effects.

Not everyone experiences side effects, only those who are susceptible.

The most side effects are most pronounced in the first week and decrease afterward or even disappear. They go away if you stop taking the medicine.

The main side effects include the following.

Sometimes

• Insomnia. If you have trouble with this, do not take the medicine just before bedtime. If you are taking the medicine once a day, take it in the morning. If you are taking the medicine twice a day, take it in the morning and at the end of the afternoon.
• Dry mouth. This can lead to more cavities in your teeth. Therefore, brush and floss extra well if you notice you have a dry mouth. Consider having your dentist check more frequently.
• Gastrointestinal problems, such as nausea, vomiting, abdominal pain, constipation, and very rarely, decreased appetite or weight loss. These side effects usually occur at the beginning of the treatment. It usually helps to take the medicine with some food. If you continue to have problems after a few days, contact your doctor.
• Headache.

Rarely

• Sleepiness, reduced concentration, dizziness, and confusion. This is particularly troublesome during activities where your full attention is needed, such as driving, climbing ladders, or monitoring a process at work. Do not engage in risky activities the first week of use and also not if you experience these side effects afterward.
• Tinnitus. If you experience this a lot, consult your doctor.
• Blurred vision. Consult your doctor if this persists.
• Anxiety, nervousness, and excitement. This occurs mainly at the beginning of treatment and usually diminishes on its own. If it persists, consult your doctor.
• Tremors, fever, and sweating.
• Skin rash, itching, and hives. In this case, consult your doctor. It may be an allergic reaction to the medicine. Very rarely, a rash with blisters, extensive redness, skin peeling, fever, swollen lips, tongue, or face, difficulty breathing, or fainting may occur. Stop using the medicine immediately and notify your doctor. In case of allergy, you should not use this medicine in the future. Inform the pharmacist that you are allergic to bupropion. The pharmacy team can then ensure that you do not receive the medicine again.

Very rarely

• People with epilepsy are at risk of an increase in the number of seizures. Consult your doctor about this. The risk of an epileptic seizure is also higher in the following situations: with a tumor in the head or other head injury, in people who have had an eating disorder, such as anorexia or bulimia, and people with diabetes whose blood glucose is not well controlled.
• Coordination disorders and decreased muscle strength.
• Memory disorders and taste disorders.
• Heart problems, such as palpitations, chest pain, accelerated heartbeat, or slowed heartbeat. Consult your doctor if you experience these symptoms. People with Brugada syndrome, an inherited heart condition, may have a greater risk of heart rhythm disorders. Consult your doctor. You may need to switch to another medicine. If you still need to use this medicine, your doctor will monitor you more closely.
• High or low blood pressure and flushing. Have your blood pressure checked regularly. Consult your doctor if you experience dizziness or fainting.
• Hallucinations (seeing and hearing things that are not real). Consult your doctor in that case.
• Liver problems. You may notice this by a sensitive, swollen abdomen or yellowing of the whites of the eyes or skin. Consult your doctor if you experience these symptoms.
• Mood changes, increased depressive thoughts, hostile feelings towards oneself or others, alienation from one’s own personality. This can manifest as aggression, self-harm, or thoughts of suicide. Contact your doctor if depressive feelings increase or change in nature, or if hostile feelings develop or worsen. Young people (under 30 years old) are more likely to experience these side effects. Doctors usually do not prescribe this medicine to individuals under 18 years old.

Consult your doctor if you experience too many of the above-mentioned side effects or if you experience other side effects that concern you.

Explanation of frequencies

Commonly: in more than 30 out of 100 people
Sometimes: in 10 to 30 out of 100 people
Rarely: in 1 to 10 out of 100 people
Very rarely: in less than 1 out of 100 people

Does Wellbutrin XL interact with other medicines?

This medicine interacts with other medicines. Only the active ingredients of these medicines are mentioned in the text below, not the brand names. You can check if your medicine contains any of these active ingredients in your package leaflet under the heading ‘composition.’

The medicines with which the most significant interactions occur are as follows.

• Other medicines that decrease reaction time. These medicines often have a yellow warning sticker on the packaging. The effects on, for example, reaction time and coordination enhance each other. Do not drive a car if you are using bupropion along with another medicine that affects reaction time.
• Some medicines for depression, namely amitriptyline, clomipramine, dosulepine, doxepin, imipramine, and nortriptyline. Bupropion inhibits the breakdown of these medicines. This increases the amount of these medicines in the blood. You may experience more side effects, such as drowsiness, dizziness, constipation, dry mouth, or difficulty urinating. Moreover, a serious side effect may occur if you use these medicines along with bupropion. You may experience muscle twitching, tremors, fever, sweating, excitement, and confusion. Consult your doctor.
• Vortioxetine, a medicine for depression. The amount of vortioxetine in the blood increases. Your doctor may reduce the dosage.
• Venlafaxine, a medicine for depression. This medicine inhibits the breakdown of venlafaxine. You may experience more side effects such as drowsiness, nervousness, gastrointestinal problems, tremors, palpitations, and dizziness. Contact your doctor if you notice this. Your doctor will monitor you more closely or prescribe another medicine.
• Atomoxetine, a medicine for ADHD, metoprolol, a medicine for high blood pressure, and aripiprazole, perfenazine and risperidone, medicines for psychosis. The amount of these medicines in the blood increases. Your doctor may reduce the dosage or prescribe another medicine.
• Tamoxifen, used for certain types of breast cancer. Bupropion may reduce the effectiveness of tamoxifen. Consult your doctor. You may switch to another medicine.
• Some medicines for HIV. Ask your pharmacist which medicines these are.

The following interactions apply only if you are using bupropion to quit smoking. Smoking accelerates the breakdown of various medicines. If you quit smoking, the amount of those medicines in the blood may increase. This can make them work more effectively or cause side effects. If you use these medicines, consult your doctor before quitting smoking.

• Theophylline, a bronchodilator. Your doctor will monitor the amount of theophylline in your blood.
• Insulin, used for diabetes.
• If you stop smoking, you will need less insulin. Therefore, check your blood glucose level extra if you have stopped.
• Flecainide, a medication for heart rhythm disorders. After quitting smoking, a dose reduction may be necessary.
• Cardiovascular drugs of the beta-blocker type, such as atenolol, bisoprolol, metoprolol, and propranolol. After quitting smoking, a dose reduction may be necessary.
• Antipsychotics clozapine, haloperidol, and olanzapine. After quitting smoking, a dose reduction may be necessary.

Are you unsure whether any of the above interactions are of concern to you? Then contact your pharmacist or doctor.

If I use Wellbutrin, may I…

drive?
It can be dangerous to participate in traffic if you are using this medication. This is due to side effects such as dizziness, confusion, difficulty concentrating, and blurred vision. You should not drive during the first week you are using this medication. Also, do not drive if the dosage is increased. Only after you have used the same dosage for 1 week may you drive again.
After a week, most people are sufficiently accustomed to the effects. You may then drive again. But only do so if you no longer suffer from the side effects.

drink alcohol?
Alcohol in combination with bupropion increases the risk of concentration disorders and epileptic seizures. Therefore, limit the use of alcohol and preferably do not drink it. People who use alcohol excessively or are withdrawing from alcohol should not use bupropion.

eat anything?
There are no restrictions with this medication.

May I use Wellbutrin if I am pregnant or breastfeeding?

Pregnancy
Notify your doctor and pharmacist as soon as you are pregnant, or plan to become pregnant soon. Together with your doctor, you can discuss the risk to the baby if you continue the medication. Or what the risk to you is if you stop the medication. There is a risk of side effects in the child at the end of pregnancy with the use of this medication. The baby may have withdrawal symptoms after birth. But it can also be harmful to the baby or to you if your condition is not treated properly. Therefore, discuss the pros and cons with your doctor. You may be able to (temporarily) switch to another medication.

Breastfeeding
If you want to breastfeed, discuss this with your doctor. You should NOT use this medication if you are breastfeeding. This medication passes into breast milk and can thus be harmful to the baby. The doctor may prescribe you (temporarily) another medication that is known to be safe to use.

What should I do if I miss a dose?

It is important that you continue to take this medication consistently. If you do forget a dose:

• If you are using this medication for smoking cessation and ADHD: is it more than 8 hours until you normally take the next dose? Then take the missed dose. Is it less than 8 hours? Then skip the missed dose.
• If you are using this medication for depression: skip the missed dose and take your next tablet at the usual time. Do not take a tablet to make up for a missed dose.

Can I stop taking Wellbutrin abruptly?
For smoking cessation
After several weeks of use, you can stop at once. Sometimes the doctor advises to taper off gradually to minimize the risk of withdrawal symptoms.

For depression
Preferably stop gradually. Consult your doctor about this. Suddenly stopping may cause withdrawal symptoms.

Also, be aware that the effect of bupropion is maximal after six weeks of use and you should continue taking the medication for at least six more months. If you stop earlier, you are more likely to experience a recurrence of depression.

When using this medication for depression, it is often tapered off over several months to prevent the symptoms of depression from recurring.

For ADHD
Preferably stop gradually. Suddenly stopping may cause withdrawal symptoms. This also prevents disappointment if the old behavior returns in full force.