Bupropion
Norepinephrine-Dopamine Reuptake Inhibitor (NDRI) Antidepressant
Bupropion is an atypical antidepressant that works by inhibiting the reuptake of norepinephrine and dopamine in the brain. Unlike most other antidepressants, bupropion has minimal effect on serotonin and is therefore classified as a norepinephrine-dopamine reuptake inhibitor (NDRI). It is primarily prescribed for the treatment of major depressive disorder in adults. Bupropion is notable for its lower risk of sexual side effects and weight gain compared to SSRIs and SNRIs, making it a valuable option for patients who experience these problems with other antidepressants. The modified-release formulation is taken once daily, usually in the morning.
Quick Facts: Bupropion
Key Takeaways
- Bupropion treats depression via a unique mechanism: It is a norepinephrine-dopamine reuptake inhibitor (NDRI) that does not significantly affect serotonin, setting it apart from SSRIs and SNRIs. This unique profile means fewer sexual side effects and less weight gain.
- Allow several weeks for full effects: Bupropion takes time to work. Some improvement may appear within the first 2 weeks, but full therapeutic benefit typically requires 4 to 6 weeks of consistent treatment at the correct dose.
- Seizure risk is dose-dependent: Bupropion can cause seizures in approximately 1 in 1,000 people at recommended doses. The risk increases at higher doses and in patients with predisposing conditions such as epilepsy, eating disorders, or a history of heavy alcohol use.
- Do not combine with MAO inhibitors: At least 14 days must pass between stopping an MAO inhibitor and starting bupropion, or vice versa, to prevent serious and potentially life-threatening interactions.
- Swallow tablets whole: Modified-release tablets must not be crushed, chewed, or split, as this destroys the controlled-release mechanism and increases the risk of seizures and other side effects due to rapid drug release.
What Is Bupropion and What Is It Used For?
Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) prescribed for the treatment of major depressive disorder in adults. It works by increasing the levels of norepinephrine and dopamine in the brain — two neurotransmitters closely linked to mood, motivation, and concentration — without significantly affecting serotonin.
Bupropion belongs to the aminoketone class of antidepressants and is chemically distinct from all other currently available antidepressant drug classes, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Its primary mechanism of action involves the inhibition of neuronal reuptake of norepinephrine (noradrenaline) and dopamine, with minimal effect on the serotonin system. This makes bupropion pharmacologically unique among antidepressants and gives it a distinctive clinical profile.
The decision to prescribe bupropion is often influenced by its favorable side effect profile. Because it does not primarily act on serotonin, bupropion is substantially less likely to cause the sexual dysfunction (such as decreased libido, delayed orgasm, and erectile dysfunction) that commonly occurs with SSRIs like fluoxetine, sertraline, or escitalopram. Additionally, bupropion is generally weight-neutral or may even be associated with modest weight loss, in contrast to many other antidepressants that frequently cause weight gain. These characteristics make bupropion a particularly useful option for patients who have discontinued other antidepressants due to sexual side effects or unwanted weight changes.
It is important to understand that bupropion does not produce immediate relief of depressive symptoms. Like all antidepressant medications, it requires several weeks of consistent use before the full therapeutic effect becomes apparent. Most patients begin to notice some improvement within the first 1 to 2 weeks, but the medication typically reaches its full effect after 4 to 6 weeks of treatment. During this initial period, it is essential to continue taking the medication as prescribed, even if you do not feel an immediate benefit. Your doctor may recommend continuing bupropion for a sustained period after symptoms resolve to prevent relapse of depression.
Approved Uses
In most countries, bupropion modified-release tablets are approved for the treatment of major depressive disorder (MDD) in adults. The modified-release formulation available in Europe (including brands such as Voxra) is designed for once-daily dosing and is specifically indicated for depression. In some markets, particularly the United States (where it is marketed as Wellbutrin), bupropion is also approved for the prevention of seasonal affective disorder (SAD) and, under the brand name Zyban, as an aid for smoking cessation. However, the approved indications may vary by country, and you should always follow the prescribing information relevant to your region.
Bupropion is sometimes used off-label for conditions such as attention-deficit/hyperactivity disorder (ADHD) in adults, obesity-related weight management (in combination with naltrexone), and as an augmentation strategy in treatment-resistant depression when combined with an SSRI or SNRI. These off-label uses should only be considered under the supervision of a qualified healthcare professional.
How Does Bupropion Work?
Depression is associated with imbalances in brain neurotransmitter systems, particularly norepinephrine, dopamine, and serotonin. While most commonly prescribed antidepressants (such as SSRIs) primarily target the serotonin system, bupropion takes a different approach by targeting norepinephrine and dopamine. These two neurotransmitters are critically involved in regulating mood, motivation, energy levels, reward processing, and concentration — symptoms that are often prominently impaired in depression.
Bupropion works by blocking the reuptake transporters for norepinephrine and dopamine on nerve cells. Normally, after these neurotransmitters are released into the synaptic cleft (the gap between nerve cells), they are quickly reabsorbed by the releasing nerve cell through reuptake transporters. By blocking this reabsorption, bupropion allows norepinephrine and dopamine to remain in the synaptic cleft for longer, enhancing their signaling and improving mood and motivation.
Bupropion is extensively metabolized in the liver, primarily by the cytochrome P450 enzyme CYP2B6, to several active metabolites. The most pharmacologically significant metabolite is hydroxybupropion, which has similar potency to the parent compound and achieves higher plasma concentrations. The elimination half-life of bupropion is approximately 20 hours, and the half-life of hydroxybupropion is also approximately 20 hours, which supports once-daily dosing with the modified-release formulation. Steady-state plasma concentrations are typically achieved within 5 to 8 days of consistent dosing.
Bupropion is the only widely used antidepressant that acts directly on the dopamine system. Dopamine plays a central role in motivation, pleasure, and reward — functions that are often severely disrupted in depression. This dopaminergic activity may be particularly beneficial for patients whose depression is characterized by apathy, lack of motivation, fatigue, and difficulty concentrating, sometimes referred to as “atypical” or “anergic” depression.
What Should You Know Before Taking Bupropion?
Before taking bupropion, tell your doctor about all medical conditions, especially seizure disorders, eating disorders, liver disease, kidney disease, diabetes, bipolar disorder, or a history of heavy alcohol use. Bupropion must not be used if you have epilepsy, an eating disorder, a brain tumor, or if you have recently stopped using alcohol or sedatives.
Bupropion has several important contraindications and precautions that distinguish it from other antidepressants. The most significant risk associated with bupropion is its dose-dependent potential to cause seizures, which occurs in approximately 1 in 1,000 patients at recommended doses. Many of the contraindications and warnings listed below are specifically aimed at minimizing this seizure risk.
Contraindications
Bupropion must not be taken in the following situations:
- Allergy to bupropion or any other ingredient in the formulation. Signs of an allergic reaction include skin redness, rash, hives, blisters, itching, swelling of the eyelids, lips, or tongue, difficulty breathing, and collapse. If you experience any of these symptoms, stop taking bupropion and seek medical attention immediately.
- Use of any other medication containing bupropion. Taking two bupropion-containing products simultaneously increases the risk of seizures.
- Epilepsy or any history of seizures. Bupropion lowers the seizure threshold and is contraindicated in patients with seizure disorders.
- Current or past eating disorders such as bulimia nervosa or anorexia nervosa. Patients with eating disorders have an elevated risk of bupropion-induced seizures.
- Brain tumor. Central nervous system tumors are associated with an increased seizure risk.
- Recent or planned discontinuation of alcohol. If you have a history of heavy alcohol use and have recently stopped or plan to stop drinking, the withdrawal state significantly increases the risk of seizures.
- Recent or planned discontinuation of sedative medications (such as benzodiazepines). Sedative withdrawal increases seizure risk.
- Severe liver disease. Bupropion is extensively metabolized by the liver, and severe hepatic impairment can lead to dangerous accumulation of the drug.
- Concurrent or recent use of MAO inhibitors. At least 14 days must pass between stopping an MAO inhibitor (such as moclobemide, tranylcypromine, or selegiline) and starting bupropion, or vice versa, due to the risk of severe hypertensive reactions.
Warnings and Precautions
Talk to your doctor or pharmacist before taking bupropion if any of the following apply to you:
- Regular heavy alcohol consumption: Even if you do not plan to stop drinking, alcohol use increases the risk of seizures with bupropion. Your doctor will weigh the benefits against the risks. Importantly, do not abruptly stop drinking alcohol when starting bupropion, as withdrawal also increases seizure risk.
- Diabetes treated with insulin or oral hypoglycemic agents: Bupropion may affect blood sugar levels, and your doctor may need to adjust your diabetes medication.
- History of serious head injury or head trauma: Previous brain injury increases seizure susceptibility.
- Bipolar disorder (manic depression): Bupropion may trigger a manic episode. Your doctor should assess your risk before prescribing this medication.
- Liver or kidney disease: Impaired organ function can lead to drug accumulation and an increased risk of side effects. Dose adjustments may be necessary.
- Brugada syndrome: This is a rare inherited heart rhythm disorder. If you have Brugada syndrome or a family history of sudden cardiac death, inform your doctor before starting bupropion.
Bupropion causes seizures in approximately 1 in 1,000 people at recommended doses. The risk is higher if you take too much, if you take certain other medications that lower the seizure threshold, or if you have a predisposing condition. If you experience a seizure while taking bupropion, stop taking the medication immediately and contact your doctor. Do not take any further doses.
Suicidal Thoughts and Worsening Depression
Patients with depression may sometimes have thoughts of self-harm or suicide. These thoughts may paradoxically intensify when first starting antidepressant treatment, because the medication typically takes at least 2 weeks to begin producing its therapeutic effect. This risk is particularly relevant in the following situations:
- Patients who have previously had thoughts of self-harm or suicide
- Young adults under 25 years of age — clinical studies have shown an increased risk of suicidal thinking in this age group during early treatment with antidepressants
If you experience thoughts of self-harm or suicide at any point during treatment, contact your doctor immediately or seek emergency care. It can be helpful to tell a family member or close friend about your condition and ask them to monitor whether you seem to be getting worse or whether your behavior is changing.
Children and Adolescents
Bupropion is not recommended for the treatment of depression in patients under 18 years of age. There is an increased risk of suicidal thoughts and suicidal behavior when children and adolescents under 18 are treated with antidepressant medications. If a doctor prescribes bupropion for a young person in exceptional circumstances, the patient should be closely monitored for any worsening of depression, suicidal behavior, or unusual changes in behavior.
Pregnancy and Breastfeeding
Pregnancy: Bupropion should not be used during pregnancy unless your doctor has carefully considered the benefits and determined they outweigh the potential risks to the developing fetus. Some epidemiological studies have reported a possible association between bupropion use during the first trimester and an increased risk of certain congenital malformations, particularly congenital heart defects. However, these findings have not been consistent across all studies, and a definitive causal relationship has not been established. If you are pregnant, think you might be pregnant, or are planning to become pregnant, discuss the risks and benefits of treatment with your doctor before starting or continuing bupropion.
Breastfeeding: Bupropion and its active metabolites pass into breast milk. Because the potential effects on the nursing infant are not fully known, your doctor should weigh the benefits of breastfeeding and the benefits of continuing bupropion treatment against any potential risks to the baby. You should consult your doctor or pharmacist before taking bupropion while breastfeeding.
Driving and Operating Machinery
Bupropion may cause dizziness, lightheadedness, or impaired concentration in some patients. If you experience these effects, do not drive, operate machinery, or engage in activities that require full alertness until you are confident that your ability is not affected. As with all medications that affect the central nervous system, individual responses vary, and you are responsible for assessing your own fitness to drive or perform tasks requiring concentration.
Alcohol
Alcohol and bupropion can interact in several important ways. Alcohol can affect how bupropion works in the body and, in rare cases, may affect the nervous system or mental health. Some patients experience an increased sensitivity to alcohol while taking bupropion. Your doctor may advise you to avoid alcohol entirely or drink very sparingly during treatment. Importantly, if you currently drink heavily, do not stop alcohol abruptly, as sudden alcohol withdrawal significantly increases the risk of seizures — which is the most important risk associated with bupropion. Discuss your drinking habits honestly with your doctor before starting treatment.
Effects on Urine Tests
Bupropion can interfere with certain urine drug screening tests, potentially causing false-positive results for amphetamines. If you need to undergo a urine drug test for any reason, inform the testing laboratory and your doctor that you are taking bupropion so that confirmatory testing can be performed if necessary.
How Does Bupropion Interact with Other Drugs?
Bupropion has significant drug interactions that can increase the risk of seizures or alter the effectiveness of other medications. MAO inhibitors are absolutely contraindicated. Many medications that lower the seizure threshold should be used with extreme caution. Bupropion also inhibits CYP2D6, which can increase the blood levels of drugs metabolized by this enzyme.
Bupropion is metabolized primarily by the cytochrome P450 enzyme CYP2B6, and it is a potent inhibitor of CYP2D6. This means that bupropion can increase the blood levels of other drugs that are metabolized by CYP2D6, potentially increasing their effects and side effects. Additionally, drugs that induce or inhibit CYP2B6 can alter bupropion levels in the blood. Beyond these pharmacokinetic interactions, bupropion has important pharmacodynamic interactions related to its effect on the seizure threshold.
Major Interactions (Avoid Combination)
| Drug / Class | Risk | Action Required |
|---|---|---|
| MAO inhibitors (moclobemide, tranylcypromine, selegiline) | Severe hypertensive reactions, potential serotonin syndrome-like toxicity | Contraindicated. Wait at least 14 days between stopping one and starting the other |
| Other bupropion-containing products | Dose-dependent seizure risk | Never combine. Use only one bupropion product at a time |
Increased Seizure Risk
The following medications and substances, when combined with bupropion, can significantly increase the risk of seizures. Your doctor will carefully weigh the benefits against the risks before prescribing bupropion alongside any of these:
- Other antidepressants (SSRIs, SNRIs, tricyclics, other antidepressants)
- Antipsychotic medications (such as clozapine, risperidone, thioridazine, olanzapine)
- Theophylline (used for asthma and chronic lung disease)
- Tramadol (a strong pain reliever with serotonergic properties)
- Sedatives and hypnotics (if stopped abruptly during bupropion treatment)
- Antimalarial drugs (mefloquine, chloroquine)
- Stimulants and appetite suppressants
- Systemic corticosteroids (in tablet form or by injection)
- Quinolone antibiotics
- Sedating antihistamines
- Diabetes medications (insulin and oral hypoglycemics, if they cause hypoglycemia)
Drugs Affected by Bupropion (CYP2D6 Inhibition)
Bupropion is a potent inhibitor of the CYP2D6 enzyme. This means it can increase the blood levels — and therefore the effects and side effects — of many medications that depend on CYP2D6 for their metabolism. The following table summarizes the most clinically significant interactions:
| Drug / Class | Effect | Action Required |
|---|---|---|
| Tricyclic antidepressants (desipramine, imipramine, dosulepin) | Increased blood levels; risk of toxicity | Lower doses of the tricyclic may be needed; monitor closely |
| SSRIs (fluoxetine, paroxetine, citalopram, escitalopram) | Increased SSRI levels; serotonin syndrome risk | Monitor for serotonergic symptoms (agitation, tremor, fever, diarrhea) |
| Venlafaxine | Increased venlafaxine levels; serotonin syndrome risk | Use with caution; monitor for mental status changes |
| Beta-blockers (metoprolol) | Increased metoprolol levels; excessive heart rate reduction | Monitor heart rate and blood pressure |
| Antiarrhythmics (propafenone, flecainide) | Increased antiarrhythmic levels; risk of cardiac toxicity | Dose adjustment; cardiac monitoring recommended |
| Antipsychotics (risperidone, thioridazine, clozapine) | Increased antipsychotic levels | Monitor for increased side effects; dose adjustment may be needed |
| Tamoxifen (breast cancer treatment) | Reduced conversion to active metabolite (endoxifen); potentially decreased efficacy | Consider alternative antidepressant if taking tamoxifen for breast cancer |
| Digoxin | Potentially reduced digoxin efficacy | Monitor digoxin levels; dose adjustment may be necessary |
Drugs That Reduce Bupropion Effectiveness
Certain medications can induce CYP2B6 or otherwise reduce bupropion blood levels, potentially diminishing its antidepressant effect:
- Ritonavir and efavirenz (antiretroviral drugs for HIV) — can significantly reduce bupropion levels. Your doctor should monitor your response and may need to consider alternative antidepressant therapy. Do not increase your bupropion dose without medical supervision, as this raises the seizure risk.
- Carbamazepine, phenytoin, and valproate (anti-epileptic drugs) — may reduce bupropion levels through enzyme induction.
Bupropion and Nicotine Replacement Therapy
If you are using nicotine patches while taking bupropion (for example, during a smoking cessation program), be aware that the combination may increase the risk of elevated blood pressure. Your doctor should monitor your blood pressure if you are using both treatments concurrently.
Anticoagulants
Bupropion may interact with warfarin and other anticoagulants. There have been rare reports of altered INR (international normalized ratio) values in patients taking bupropion alongside warfarin. If you are taking an anticoagulant, your doctor should monitor your blood clotting parameters more closely when starting, adjusting, or stopping bupropion.
Levodopa and Amantadine
Patients taking levodopa or amantadine (used for Parkinson’s disease) should use bupropion with caution. Clinical experience suggests that these combinations may increase the risk of side effects such as nausea, vomiting, and psychiatric disturbances (including restlessness, agitation, and tremor). If bupropion is added to an existing levodopa or amantadine regimen, careful dose titration and close monitoring are recommended.
What Is the Correct Dosage of Bupropion?
The usual starting dose of bupropion modified-release tablets is 150 mg once daily, taken in the morning. If there is insufficient improvement after several weeks, the dose may be increased to 300 mg once daily. The tablet must be swallowed whole and must not be crushed, chewed, or split.
Always take bupropion exactly as your doctor or pharmacist has instructed. The dosing information below represents standard recommendations, but your doctor’s prescription is personalized for your individual situation. Do not change your dose without consulting your doctor.
Adults
Standard Adult Dosage
Starting dose: 150 mg once daily, taken in the morning
Maintenance dose: 150–300 mg once daily
Maximum dose: 300 mg once daily
Your doctor may increase the dose to 300 mg per day if your depression does not improve after several weeks at 150 mg. Bupropion should be taken in the morning, as it may cause insomnia if taken later in the day. Take the tablet at the same time each day, and never take more than one dose per day.
How to Take Modified-Release Tablets
Bupropion modified-release tablets are coated with a special shell that slowly releases the medication into your body over time. This controlled-release mechanism is essential for maintaining safe and effective drug levels throughout the day. You may occasionally notice something in your stool that looks like a tablet — this is simply the empty shell after the medication has been released.
Swallow the tablets whole with water. Do not chew, crush, or split the tablets. Breaking the modified-release mechanism causes the entire dose to be released at once, which significantly increases the risk of side effects, including seizures. This is critically important for the safety of bupropion treatment.
Liver and Kidney Impairment
Dose Adjustments for Organ Impairment
If you have liver disease or kidney disease, your doctor may keep you on the lower dose of 150 mg per day throughout treatment, or may prescribe fewer doses per week. Bupropion is extensively metabolized in the liver and its metabolites are eliminated through the kidneys. Impaired organ function can cause accumulation of the drug and its active metabolites, increasing the risk of adverse effects.
Elderly Patients
Elderly Dosage
The same dosage range applies to elderly patients. However, elderly patients may be more sensitive to the effects of bupropion, particularly central nervous system effects. Your doctor may choose to maintain the lower 150 mg daily dose and increase more cautiously based on your response and tolerability.
Children and Adolescents
Pediatric Use
Bupropion is not recommended for use in patients under 18 years of age for the treatment of depression. There is an increased risk of suicidal thoughts and suicidal behavior in this age group when treated with antidepressant medications.
Duration of Treatment
The duration of bupropion treatment should be determined by you and your doctor together. It may take weeks or even months before you notice significant improvement in your depressive symptoms. Discuss your progress with your doctor regularly. Once you begin to feel better, your doctor may advise you to continue taking bupropion for an extended period to prevent relapse of depression. Treatment duration is typically at least 6 months after symptoms resolve, but may be longer depending on your individual circumstances and history of depression.
Missed Dose
If you forget to take a dose, wait until the next scheduled dosing time and take your regular dose. Do not take a double dose to make up for a missed dose. Taking extra bupropion increases the risk of seizures.
Overdose
If you or someone else takes too much bupropion, seek emergency medical attention immediately by contacting your local emergency services, going to the nearest emergency room, or calling your regional poison control center. Do not wait for symptoms to appear.
Bupropion overdose is associated with an increased risk of seizures. Other symptoms of overdose may include drowsiness, loss of consciousness, rapid heart rate (tachycardia), and cardiac conduction disturbances. In severe cases, overdose can be life-threatening.
Bupropion overdose can cause seizures and may be life-threatening, particularly when combined with alcohol or other medications. If overdose is suspected, do not wait for symptoms — seek emergency medical care immediately. Take the tablet packaging with you so that medical staff can identify the medication and dosage.
Stopping Treatment
Do not stop taking bupropion or reduce the dose without first discussing it with your doctor. Although bupropion is generally considered to have a lower risk of discontinuation symptoms compared to SSRIs and SNRIs, abrupt cessation of any antidepressant can potentially lead to a return of depressive symptoms. Your doctor will advise you on the best approach for tapering or discontinuing treatment when appropriate.
What Are the Side Effects of Bupropion?
The most common side effects of bupropion are insomnia, headache, dry mouth, and nausea. Unlike many other antidepressants, bupropion rarely causes sexual dysfunction or weight gain. The most serious risk is seizures, which occur in approximately 1 in 1,000 patients at recommended doses. Allergic reactions can also occur and require immediate medical attention.
Like all medications, bupropion can cause side effects, although not everyone will experience them. Most side effects are mild to moderate and tend to diminish as your body adjusts to the medication. However, some side effects are serious and require prompt medical attention. The side effects listed below are organized by frequency, based on clinical trial data and post-marketing surveillance.
Serious Side Effects
The following side effects are serious and require immediate medical attention:
Bupropion causes seizures in approximately 1 in 1,000 people at recommended doses. The risk is higher if you take more than the prescribed dose, if you take other medications that lower the seizure threshold, or if you have a condition that predisposes you to seizures. If you experience a seizure, tell your doctor as soon as you have recovered. Do not take any more tablets.
Some people develop allergic reactions to bupropion. Symptoms include: skin redness, rash, hives, blisters, itching, swelling of the eyelids, lips, or tongue, difficulty breathing or wheezing, muscle or joint pain, and collapse or temporary loss of consciousness. Certain types of skin reactions may require hospitalization. If you notice any signs of an allergic reaction, stop taking bupropion and contact your doctor immediately. Allergic reactions to bupropion can persist for an extended period; if your doctor prescribes treatment for the allergic symptoms, complete the full course.
Very Common
May affect more than 1 in 10 people
- Insomnia (difficulty sleeping) — take bupropion in the morning to minimize this
- Headache
- Dry mouth
- Nausea, vomiting
Common
May affect up to 1 in 10 people
- Fever, dizziness, itching, sweating, skin rash (sometimes due to allergic reaction)
- Tremor (shaking), weakness, fatigue, chest pain
- Anxiety, agitation
- Abdominal pain, constipation, taste changes
- Loss of appetite (anorexia)
- Elevated blood pressure (sometimes severe), flushing
- Tinnitus (ringing in the ears), visual disturbances
Uncommon
May affect up to 1 in 100 people
- Depression (worsening of existing symptoms)
- Confusion
- Difficulty concentrating
- Increased heart rate (tachycardia)
- Weight loss
Rare
May affect up to 1 in 1,000 people
- Seizures (convulsions)
Very Rare
May affect up to 1 in 10,000 people
- Palpitations (awareness of heartbeat), fainting
- Muscle twitching, stiffness, uncontrolled movements, coordination problems
- Restlessness, irritability, hostility, aggression, unusual dreams
- Numbness, tingling sensations, memory loss
- Yellowing of the skin or eyes (jaundice), elevated liver enzymes, hepatitis
- Severe allergic reactions including joint and muscle pain
- Blood sugar disturbances
- Changes in urinary frequency or urinary incontinence
- Severe mouth or skin reactions (potentially life-threatening)
- Worsening of psoriasis
- Hair loss or thinning (alopecia)
- Depersonalization, hallucinations, delusions, severe paranoia
Frequency Not Known
Cannot be estimated from available data
- Suicidal thoughts or behavior during treatment or shortly after stopping
- Psychosis (loss of contact with reality, inability to think clearly)
- Panic attacks
- Stuttering
- Anemia (reduced red blood cells), leukopenia (reduced white blood cells), thrombocytopenia (reduced platelets)
- Hyponatremia (low sodium levels in the blood)
- Serotonin syndrome symptoms when combined with serotonergic drugs (agitation, hallucinations, fever above 38°C, rapid heart rate, unstable blood pressure, muscle rigidity, lack of coordination, gastrointestinal symptoms)
- Lupus-like skin rash or worsening of existing lupus symptoms
- Acute generalized exanthematous pustulosis (AGEP) — widespread rash with pus-filled blisters
It is important to report suspected side effects after a medication has been approved for use. This allows ongoing monitoring of the benefit-risk balance. Healthcare professionals and patients can report suspected adverse reactions to their national medicines regulatory authority (such as the FDA in the United States, the EMA in Europe, or the MHRA in the United Kingdom).
How Should You Store Bupropion?
Store bupropion at room temperature, out of the sight and reach of children. No special storage conditions are required. Do not use after the expiry date printed on the packaging.
Keep bupropion out of the sight and reach of children at all times. Do not use the medication after the expiry date stated on the carton and blister packaging — the expiry date refers to the last day of the stated month.
This medication does not require any special storage conditions. Store it at room temperature, away from excessive heat and moisture. Do not store it in the bathroom, where humidity levels may be high.
Do not dispose of medications by flushing them down the toilet or pouring them into household drains. Ask your pharmacist how to safely dispose of medications you no longer use. Proper disposal helps protect the environment and prevents accidental exposure.
What Does Bupropion Contain?
Each modified-release tablet contains 150 mg of the active ingredient bupropion hydrochloride, along with inactive ingredients that form the tablet core and the modified-release coating.
Active Ingredient
The active substance is bupropion hydrochloride. Each modified-release tablet contains 150 mg of bupropion hydrochloride.
Inactive Ingredients (Excipients)
The other ingredients serve various pharmaceutical functions, including binding the tablet, controlling the rate of drug release, and protecting the tablet core:
- Tablet core: Povidone, cysteine hydrochloride monohydrate, colloidal anhydrous silica, glycerol dibehenate, magnesium stearate (E 470b)
- Coating: Ethylcellulose, povidone, macrogol, methacrylic acid – ethyl acrylate copolymer (1:1) (containing sodium lauryl sulfate and polysorbate 80), colloidal hydrated silica, triethyl citrate
- Printing ink: Shellac, black iron oxide (E172), propylene glycol
Appearance and Pack Sizes
Bupropion modified-release tablets are cream-white to pale yellow, round tablets approximately 7.2 mm in diameter. Depending on the manufacturer, they may be imprinted with an identification code on one side. The tablets are available in blister packs of 10, 30, 60, or 90 tablets. Not all pack sizes may be marketed in all countries.
Frequently Asked Questions About Bupropion
Bupropion typically takes several weeks before you notice significant improvement in depressive symptoms. Some patients begin to feel better within 1 to 2 weeks, but full therapeutic benefit usually requires 4 to 6 weeks of consistent treatment. If your symptoms have not improved after several weeks at 150 mg daily, your doctor may increase the dose to 300 mg daily. It is essential to continue taking bupropion as prescribed, even during the initial period when you may not yet feel an improvement, as stopping prematurely can prevent the medication from reaching its full effect.
No, bupropion is one of the few antidepressants that is generally weight-neutral or may even promote modest weight loss. Loss of appetite is listed as a common side effect. This is a significant advantage over many other antidepressant medications, including SSRIs (such as sertraline and citalopram), SNRIs, tricyclic antidepressants, and mirtazapine, all of which are commonly associated with weight gain. If weight is a concern for you, discuss this with your doctor when choosing an antidepressant.
It is generally advisable to minimize or avoid alcohol while taking bupropion. Alcohol can increase the risk of seizures, which is the most significant adverse effect of bupropion. Some patients also experience an increased sensitivity to alcohol during treatment. However, if you currently drink heavily, do not stop alcohol abruptly when starting bupropion, because sudden alcohol withdrawal itself increases seizure risk. Talk to your doctor about your drinking habits before beginning treatment so that a safe plan can be made.
Yes, seizures are a known risk with bupropion, occurring in approximately 1 in 1,000 patients at recommended doses. The risk is dose-dependent — it increases significantly at higher doses, which is why the maximum recommended dose is 300 mg per day for the modified-release formulation. Risk factors for seizures include a history of seizure disorders, eating disorders, brain tumors, head trauma, heavy alcohol use or abrupt alcohol withdrawal, and the concurrent use of other medications that lower the seizure threshold. If you experience a seizure, stop taking bupropion and contact your doctor immediately.
Bupropion should not be used during pregnancy unless your doctor determines that the benefits clearly outweigh the potential risks. Some studies have suggested a possible link between bupropion use in the first trimester and an increased risk of congenital heart defects, although these findings are inconsistent across studies. Bupropion and its metabolites also pass into breast milk. If you are pregnant, planning pregnancy, or breastfeeding, consult your doctor to discuss the most appropriate treatment options for your depression.
Bupropion has a significantly lower incidence of sexual side effects compared to SSRIs and SNRIs. Because bupropion acts on norepinephrine and dopamine rather than serotonin, it is much less likely to cause decreased libido, erectile dysfunction, or difficulty achieving orgasm. This characteristic is one of the main reasons bupropion is prescribed, particularly for patients who have experienced intolerable sexual dysfunction with other antidepressant classes. In some cases, bupropion is even added to an existing SSRI regimen specifically to help counteract SSRI-related sexual side effects.
References
- European Medicines Agency (EMA). Bupropion – Summary of Product Characteristics (SmPC). European public assessment reports. www.ema.europa.eu
- U.S. Food and Drug Administration (FDA). Wellbutrin XL (bupropion hydrochloride extended-release tablets) prescribing information. www.fda.gov
- National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222], 2022. www.nice.org.uk
- British National Formulary (BNF). Bupropion hydrochloride: indications, dose, contraindications, side-effects, interactions. bnf.nice.org.uk
- Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 5th ed. Cambridge University Press; 2021.
- Dhillon S, Yang LP, Curran MP. Bupropion: a review of its use in the management of major depressive disorder. Drugs. 2008;68(5):653-689. doi:10.2165/00003495-200868050-00011
- Patel K, Allen S, Haque MN, et al. Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Ther Adv Psychopharmacol. 2016;6(2):99-144. doi:10.1177/2045125316629071
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List, 2023. www.who.int
- Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. doi:10.1016/S0140-6736(17)32802-7
- Clayton AH, Croft HA, Horrigan JP, et al. Bupropion extended release compared with escitalopram: effects on sexual functioning and antidepressant efficacy in 2 randomized, double-blind, placebo-controlled studies. J Clin Psychiatry. 2006;67(5):736-746. doi:10.4088/JCP.v67n0507
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