Bupropion (Wellbutrin)
Antidepressant (norepinephrine/dopamine reuptake inhibitor and releaser)
- Major Depression1 (improves cognition)
- Nicotine2
- Restless Legs3
- ADHD3
- Methamphetamine (with naltrexone)1
Features
Dosing
Slowly (raise by 75mg/wk) if anxious or bipolar. Never go above 450 mg/d (seizures).
Give in morning. At 300 mg, IR is tid, SR is bid, XL is qam. Avoid Aplenzin (has bromides in it, expensive, and no advantage to it).
If using for antidep augmentation, works best with escitalopram/citalopram.
Management
Warn of seizures if doubles up on dose. Tremor, headache, dry mouth anxiety. It can cause a little insomnia but actually deepens sleep quality (take in morning)
Treats anxious depression as well as an SSRI although does not treat anxiety disorders. Treats ADHD. Safest antidepressant in bipolar. Varenicline is more effective for smoking cessation but can be combined with bupropion.
EMR Text
Depression
Bupropion use based on FDA approval in major depressive disorder.
Bupropion side effects, including seizures, reviewed with patient.
Bipolar
Bupropion use based on trials in bipolar depression and relatively low risk of mania with this antidepressant.
Bupropion side effects, including seizures, reviewed with patient.
Nicotine
Bupropion use based on FDA approval for nicotine cessation.
Bupropion side effects, including seizures, reviewed with patient.
Methamphetamine
Bupropion use based on randomized controlled trials in methamphetamine use disorder.
Bupropion side effects, including seizures, reviewed with patient.
ADHD
Bupropion use based on randomized controlled trials in ADHD.
Bupropion side effects, including seizures, reviewed with patient.
Restless Leg Syndrome
Bupropion use based on randomized controlled trials in restless leg syndrome.
Bupropion side effects, including seizures, reviewed with patient.