General Description

Bupropion (Wellbutrin) is a unicyclic antidepressant that is unrelated to either to the tricyclic and tetracyclic antidepressants or to the monamine oxidase inhibitors. The drug was introduced in the United States in 1985 and then withdrawn because of the occurrence of seizures in some patients. Bupropion was reintroduced in 1989 with specific recommendations regarding dose ranged to limit the occurrence of seizures.

Indications for Medication

The primary indication for bupropion is the treatment of major depressive episodes. As an antidepressant, bupropion is as effective as standard antidepressants. A small body of literature also supports the use of bupropion as an effective treatment for attention deficit disorder.

Clinical Guidelines

Initiation of bupropion should be at a low dose, perhaps starting at 100mg given orally twice a day. The titration of bupropion should be gradual, as increases in dosage should never exceed 100mg in a three-day period. The effective range for bupropion varies from 100mg to 450mg. The higher dosages should be given in three equally divided doses.

Bupropion should be given cautiously to patients with hepatic and renal disease. The use of bupropion is contraindicated in patients with seizure disorders, histories of head trauma, central nervous system (CNS) tumors, electroencephalogram (EEG) abnormalities and other brain diseases.

Bupropion is contraindicated in patients with anorexia nervosa and bulimia nervosa because of the increased incidence of possible seizure activity. Bupropion is also contraindicated in patients with a recent history of withdrawal from benzodiazepines or alcohol.

Bupropion should be used with caution in patients taking other psychotropics that might affect the seizure level, such as antipsychotics and lithium. Bupropion can be used in the elderly patient but its dose level should be increased with caution.

Adverse Effects

Some patients may experience dry mouth or constipation. Weight loss may occur in 25% of patients. The most common adverse effects are headache, insomnia, upper respiratory complaints and nausea. Restlessness, agitation and irritability may also occur. Bupropion may cause menstrual irregularities in some patients.

At dosages less than 450mg a day, the incidence of seizures is approximately 0.4% which is four-fold that of standard antidepressants. The risk of seizures increases dramatically to about 4% in dosages from 450 to 600mg a day.

The use of bupropion in pregnant women has not been studied and is not recommended during pregnancy. Bupropion is also not recommended during breast-feeding because it passes into breast milk.

Drug-Drug Interactions

Bupropion should not be administered with MAOIs. If bupropion treatment is indicated, MAOIs should be discontinued for at least two weeks prior to starting the bupropion.

Care should be used when bupropion is co-administered to patients who are taking other drugs which are metabolized by the liver such as carbamazepine, cimetidine, barbiturates and phenytoin; these drugs will effect serum levels.

Co-administration of bupropion with other antidepressants, lithium or alcohol may increase the risk of seizures. Therefore, the co-administration of bupropion with other psychotropic drugs should be handled with care.

The consent form for this medication is "Antidepressant (Anti-Obsessive-Compulsive Medication / SSRIs & dopaminergic acting medications)".