bupropion-hcl

Medically Reviewed by HaVy Ngo, Pharm.D.

Last Reviewed: Jun 07, 2022

Warnings

What are the risks of taking bupropion (Wellbutrin XL)?

Bupropion can cause serious health problems in certain groups of people. You should talk to your healthcare provider if you have any concerns or other treatment options.

Boxed warning*: Suicidal thoughts and behaviors
Risk factors: being children, adolescents, and young adults (ages 18 to 24); history of depression or other mental health condition.

Antidepressants have a boxed warning for worsening depression and suicidal ideations and behavior at the beginning of bupropion treatment. This risk increases in children, adolescents, and young adults between 18 and 24. Having depression or other mental health conditions further increases this risk. If you are taking bupropion or any other antidepressant medication, you should report any changes in your mood and behavior immediately to your doctor. Seek emergency medical help if you feel the urge for self-harm, especially during the initial few months of treatment, or at times of dose changes (either increases or decreases).

Family members and caregivers should also be alerted to watch for any unusual changes in the patient’s mood and behavior at the beginning of antidepressant medication or any time the dose is changed.

*Boxed warning, also known as black box warning, is the strictest warning that the U.S. Food and Drug Administration (FDA) can issue for a drug.

Other risks of bupropion use include:

Changes in mental health with smoking cessation treatment:
Risk factors: history of depression or any mental health condition; nicotine withdrawal symptoms

Bupropion hydrochloride sustained-release formulation (Zyban) is the only form of bupropion approved by the FDA for smoking cessation. Serious mental health adverse effects have been reported from people who have taken this form of bupropion for smoking cessation. These mental health side effects include depression, psychotic episodes (disconnection from reality), hallucinations, paranoia, aggression.
You, your family members, or your caregivers should be watching for any mood changes, including the above signs and symptoms. If you experience these mental changes, you need to stop taking bupropion immediately and let your healthcare provider know about it. Seek emergency medical help if you feel the urge for self-harm.
Seizures:
Risk factors: taking more bupropion than the prescribed dose; history of seizures or conditions that increase the risk of seizures; history of head trauma; sudden discontinuation of alcohol, benzodiazepines, barbiturates, or other seizure drugs; taking certain medications that lower the seizure threshold; having low blood sugar; using cocaine; misusing/abusing prescription CNS (central nervous system) stimulants.
Bupropion can increase your risk of seizures; this risk increases when you take more than the prescribed amount. Your risk of seizures further increases if you have other risk factors listed above. Talk to your doctor about this risk while taking bupropion. If you develop seizures on bupropion, you should stop taking bupropion and let your doctor know immediately.
High blood pressure:
Risk factors: history of high blood pressure; taking other medications that can raise blood pressure, such as monoamine oxidase inhibitors; using sustained-release bupropion and nicotine patches for smoking cessation.
Bupropion can cause high blood pressure, and this risk is higher in people who have pre-existing high blood pressure. You should regularly monitor your blood pressure at home, especially if you already have high blood pressure, or use bupropion sustained-release tablets and nicotine patches for smoking cessation. Ask your doctor what range your blood pressure should be in and inform your healthcare provider if your blood pressure rises.
Mania:
Risk factors: history of bipolar disorder
A manic episode is characterized by the feeling of extreme emotions (excessive happiness or irritability), feeling unusually more energetic, severe sleeping problems, being overactive, and having unusually grand ideas. Bipolar patients who take bupropion or any other antidepressant may experience a manic episode. This risk increases if you have a personal or family history of bipolar disorder. Let your doctor know if you have bipolar disorder, a history of mania, or if you experience any change in mood and behavior.

Speak to your doctor or pharmacist about other treatment options if you are at high risk for the above complications.

What should I tell my doctor before starting bupropion (Wellbutrin XL)?

To ensure bupropion is safe for you, before starting bupropion treatment, tell your doctor if you have ever had:

Seizures
Brain injury or spinal cord tumor
Cardiovascular diseases like high blood pressure or heart attack
Diabetes
Kidney or liver disease, especially cirrhosis
Depression, bipolar disorder, or other mental illness
If you regularly drink alcohol

What proper medical care should I take while on bupropion (Wellbutrin XL)?

MAO (monoamine oxidase) inhibitors can have dangerous drug interactions with bupropion. Examples of MAO inhibitors include phenelzine, selegiline, rasagiline, isocarboxazid, linezolid, methylene blue injection, and tranylcypromine. You should not use bupropion if you have taken an MAO inhibitor within the past 14 days. Ask your pharmacist if you are unsure if one of your medications is an MAO inhibitor.

You should only take bupropion to treat one condition at a time. Meaning, if you take bupropion for depression or anxiety, you should not also take it for smoking cessation.

Bupropion is not approved to be used by anyone younger than 18 years of age.

Younger adults are at higher risk of having suicidal thoughts and ideation at the beginning of bupropion treatment. Family members or caregivers should be informed about this risk to watch out for any changes in the patient’s mood and behavior.

Talk to your doctor if you take bupropion and you plan to get pregnant. It is unknown if bupropion will harm an unborn baby. However, untreated depression can lead to other complications such as premature birth and low birth weight, among other adverse outcomes. Discuss the risks and the benefits with your doctor. You should not start or stop taking bupropion without consulting your doctor first.

Let your doctor know immediately if you get pregnant while taking bupropion. If you are currently pregnant and taking bupropion, it is highly recommended that you enroll in the National Pregnancy Registry for Antidepressants or call 1-844-405-6185. This registry monitors the safety of certain antidepressants during pregnancy.

Consult your doctor before breastfeeding as it may not be safe to breastfeed while using bupropion. You should not take bupropion if you are allergic to it.

You should not take bupropion if you have:

Seizure disorder
An eating disorder such as anorexia or bulimia
Recent sudden discontinuation of regular alcohol intake
Recent discontinuation of a seizure medicine or a sedative, such as Klonopin, Valium, and Xanax

What drugs can interact with bupropion (Wellbutrin XL)?

Certain medications will increase your risk of having seizures while taking bupropion. You should provide your medication list and discuss the risk of this drug interaction with your healthcare provider.

This is not a complete list. Other drugs, including prescriptions, over-the-counter products, herbal supplements, and vitamins, may interact with bupropion. Not all potential drug interactions are listed in this guide. It is highly recommended to keep a list of all the drug products you are using (prescriptions, over-the-counter products, herbal supplements, natural products, and vitamins) and share it with your doctor and pharmacist.

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