Bupropion side effects and how to avoid them

Bupropion, generic for Wellbutrin, is an antidepressant used for the treatment of major depressive disorder (MDD) and seasonal affective disorder (SAD), to help people quit smoking, and several off-label uses. 

Bupropion rebalances chemicals in the brain that transmit signals between nerves, helping people better regulate their moods. Generic bupropion can be taken as immediate-release tablets, sustained-release tablets, or extended-release tablets. However, side effects will be about the same no matter what formulation is taken.

Common side effects of bupropion

Most people will experience some side effects when taking bupropion, particularly agitation (32% incidence in clinical trials), headache (26%), and insomnia (19%). The most common side effects of bupropion are:

• Agitation
• Headache
• Trouble sleeping
• Dry mouth
• Constipation
• Weight loss
• Nausea and vomiting
• Excessive sweating
• Tremors
• Appetite loss
• Sore throat
• Stuffy nose
• Dizziness
• Abdominal pain
• Infection
• Anxiety
• Skin rash
• Confusion
• Diarrhea
• Flatulence
• Palpitations
• Muscle or joint pain
• Ringing in the ears
• Abnormal dreams
• Hostility
• Frequent urination
• Chest pain

Source: DailyMed

Serious side effects of bupropion

Bupropion can cause serious side effects, including:

• Suicidal thoughts and behaviors
• Worsening of depression
• Neuropsychiatric disorders, such as psychosis, mania, hallucinations, or panic attacks
• Seizures
• Dangerously high blood pressure (hypertension)
• Irregular heartbeats
• Heart attack
• Angle-closure glaucoma
• Low sodium (hyponatremia)
• Hepatotoxicity
• Severe allergic reactions or anaphylaxis

Weight changes

Weight changes are commonly experienced by people taking bupropion, but weight loss is far more common than weight gain. Research has shown that about 14% to 23% of people taking bupropion will lose weight. Loss of appetite is a related side effect: about 1% to 18% of patients experience some appetite loss. It’s not a surprise, then, that bupropion is often prescribed off-label to help people lose weight. 

Sexual dysfunction

Bupropion, like other antidepressants, can decrease sexual desire. In clinical trials, about 3% of patients taking bupropion experienced some loss of libido. Another 3% had problems with impotence. However, bupropion is less likely to cause sexual dysfunction than selective serotonin reuptake inhibitors (SSRIs). In fact, some clinicians may prescribe it as an alternative antidepressant to people experiencing sexual dysfunction caused by SSRIs. As with any drug, get medical advice if sexual function becomes a problem while taking bupropion.

Insomnia

Trouble sleeping is one of the most common side effects of bupropion. Clinical research has shown that 11% to 20% of people taking bupropion experience insomnia compared to about 4% to 7% who have been given a placebo. This number is comparable to those who experience insomnia while taking SSRIs, which is 10% to 19%. People on bupropion can reasonably expect to have problems sleeping. If insomnia is experienced, make sure to report it to the prescribing healthcare provider.

Seizure

Though rare, seizures are a common enough problem that bupropion is never given to people with a history of seizures, anorexia, bulimia, or drug or alcohol abuse. The risk of seizures is less than one percent, but it increases with the dosage and has four times the seizure rate of other antidepressants. If seizures are experienced when taking bupropion, immediately talk to a healthcare professional. Bupropion will need to be discontinued.

Hair loss

Hair loss is only an infrequent side effect of bupropion. Less than 1% of people taking bupropion will experience hair loss side effects, and they usually only manifest after taking the drug for a while. While this is a rare side effect, research suggests that hair loss is more likely when taking bupropion than other antidepressants. In the event of hair thinning, the prescribing healthcare provider might prescribe an antidepressant that is less likely to cause hair loss.

How soon do bupropion side effects start?

Many common side effects, including agitation, headache, insomnia, dry mouth, nausea, and shaking, can appear fairly early, after one or a few days of bupropion treatment. Allergic reactions, including severe allergic reactions, could occur rapidly, even after a single dose. Others may take a few weeks or months of treatment to become apparent, including weight loss, appetite loss, constipation, sexual dysfunction, and hair loss. Most severe side effects are also delayed, particularly seizures, suicidal thoughts, and many heart problems.

How long do bupropion side effects last?

The most common side effects of bupropion usually resolve within a few days of the last dose. Bupropion has a half-life of 14 hours for a single dose and 21 hours when taken continuously, so its effects on the body can last for three to four days. Some side effects, such as weight loss, sexual dysfunction, and hair loss, may take longer to recover, but they are all generally reversible when bupropion is discontinued. 

RELATED: How long does bupropion take to work?

What are the long-term side effects of bupropion?

Some of bupropion’s severe adverse effects may have long-term or lifelong consequences, including heart attack, severe allergic reactions, and angle-closure glaucoma. If seizures are experienced, they usually stop when bupropion is discontinued. However, once a drug like bupropion causes seizures, other types of drugs that increase seizure risk may not be used in the future.

Bupropion contraindications

Because of the risk for seizures, bupropion is never prescribed to people with certain past or current medical conditions. These include:

• A history of seizures
• Anorexia or bulimia
• Anyone who is currently quitting excessive use of alcohol or being taken off benzodiazepines, barbiturates, or anticonvulsants.

Anyone with allergies to bupropion or any of the medicine’s inactive ingredients cannot safely take bupropion or Wellbutrin.

Pregnancy and nursing

Bupropion has not been shown to cause birth defects, miscarriage, or other problems when taken during pregnancy. It is uncertain if bupropion causes problems in nursing babies. It is always best to speak to a healthcare provider to weigh the risks and benefits of taking bupropion while pregnant or nursing. 

Children

The Food and Drug Administration (FDA) has not approved the use of bupropion for anyone under the age of 18 years. 

Bupropion warnings

All medications that target brain activity can cause problems. Bupropion is no exception. 

Black box warning

The FDA has mandated that bupropion and Wellbutrin carry a black box warning about the increased risk for suicidal behaviors and thoughts in young adults and adolescents using bupropion. This warning does not apply to older adults.

Cautions

Some health conditions may get worse or make serious side effects more likely in people taking bupropion, so treatment will require more careful monitoring. These include:

• Conditions that increase the risk of seizures, including stroke, head injury, brain or spinal infections, arteriovenous malformation, diabetes, or drug abuse 
• Psychiatric disorders
• Bipolar disorder
• High blood pressure
• Recent heart attack
• Uncorrected narrow angles or a history of angle-closure glaucoma
• Tourette’s syndrome or other tic disorders
• Liver problems
• Kidney problems

Abuse and dependence

The FDA does not consider bupropion to be a drug that can cause physical dependence or abuse, but it is known as a street drug. Though it doesn’t cause physical dependence, people may become psychologically addicted to the drug. Abusing bupropion by snorting, injecting, or overdosing can cause serious problems, particularly seizures. 

Overdose

Taking too much bupropion can cause serious problems. The most worrisome risks of overdose are seizures, convulsions, coma, respiratory failure, and death. Immediate emergency medical care is required if an overdose is suspected. Other symptoms of a bupropion overdose are similar to amphetamine abuse and include:

• Agitation
• Racing heart
• Hallucinations
• Abnormal heart rhythms
• Hyperactive reflexes
• Stiff or rigid muscles
• Fever

The maximum dosage depends on the dosage form prescribed and the condition being treated.

Recalls

Wellbutrin was recalled within a year of its approval because of seizures in people with eating disorders. After it was taken off the market for three years, it was relaunched with bulimia and anorexia as contraindications. 

Bupropion interactions

Combining bupropion with certain medications can cause interactions. In particular, bupropion should never be combined with:

• Monoamine oxidase inhibitors (MAOIs)
• Anticonvulsants
• Barbiturates
• Benzodiazepines
• The antipsychotic drugs pimozide or thioridazine

Because of the risk for seizures, healthcare professionals are cautious about using bupropion with:

• Tricyclic antidepressants
• Antipsychotics
• Opioids
• Stimulants
• ADHD medications
• Oral or injected corticosteroids
• Theophylline
• Gabapentinoids

Other drug interactions that may cause problems when combined with bupropion include:

• SSRIs, such as Prozac (fluoxetine) or Zoloft (sertraline)
• Certain types of beta blockers
• Certain types of heart rate medications
• Dopaminergic drugs, such as levodopa and amantadine

Alcohol and caffeine should be avoided when taking bupropion. As a stimulant, caffeine raises the risk that bupropion will cause a seizure. Combining alcohol with bupropion may provoke neuropsychiatric events.

How to avoid bupropion side effects

It’s common to have at least some adverse effects when taking bupropion. To minimize these problems, a few simple rules can help.

1. Take bupropion as directed

Follow the instructions given by a healthcare professional or written on the prescription label. Don’t take too much and don’t skip a dose. Remember that the dose amount and schedule will vary depending on the drug’s dosage form. It’s especially easy to make mistakes when switching from one dosage form to another. 

2. Don’t take a missed dose

To minimize problems, don’t try to make up a missed dose of bupropion if it is closer to the time of the next dose. Wait until the next scheduled dose to ensure you do not take double your dose.

3. Inform the healthcare provider about all medical conditions

One of the surest ways to avoid side effects is to make sure the prescriber has a full medical history. The healthcare provider needs to know about these physical conditions:

• Past or present eating disorders, especially anorexia or bulimia
• Any history of suicide, depression, or other mental illness
• Any history of mania, hypomania, or bipolar disorder
• Drinking alcohol or using illicit drugs
• Heart disease, high blood pressure, or a recent heart attack
• Diabetes
• Liver problems
• Kidney problems
• Pregnancy or plans to become pregnant
• Breastfeeding or plans to breastfeed

4. Tell the healthcare provider about all medications

A medical history is not complete without listing all of the prescription drugs, over-the-counter drugs, and dietary supplements being taken, especially:

• MAO inhibitors
• Anticonvulsants
• Sedatives
• Benzodiazepines
• Opioids

5. Avoid taking two bupropion drugs

Bupropion is not only prescribed for depression, but it’s also FDA-approved for smoking cessation. It is also popular for weight loss. For smoking cessation, the brand name was Zyban, but only the generic version is available now. For weight loss, it’s Contrave (naltrexone-bupropion). For depression, it’s Wellbutrin SR, Wellbutrin XL, Aplenzin (bupropion hydrobromide), or Forfivo XL. Understand that these are variations of the same medication and take only one of them. 

RELATED: Can you take Wellbutrin for weight loss?

6. Avoid alcohol

Alcohol and bupropion don’t mix well. When they do mix, the result could affect mental health and cause serious impairment or even seizures. Though alcohol is not strictly forbidden, the prescribing healthcare provider could ban drinking altogether in some patients. 

7. Eat a healthy diet

To avoid weight changes, adopt a healthy diet and regular exercise routine.

8. Don’t stop taking bupropion

Stopping bupropion suddenly can result in unpleasant side effects. If bupropion is not working or the side effects are difficult to endure, get medical advice from your healthcare provider. A tapering dosing regimen should be used to ease the body off of bupropion and avoid discomfort.

How to treat side effects of bupropion

If bupropion causes problems, there are ways to manage them. In some cases, it may require medical help or advice. Others might be solvable with lifestyle modifications.

Insomnia

Insomnia can occur while taking bupropion, but it often goes away within a few weeks of adjusting to the medication. 

If sleeplessness persists, speak to the prescriber about possibly changing the dosage form or time of dosing. Studies have shown that once-daily dosing of bupropion XL in the morning led to lower concentration levels in the evenings compared to the SR formulation. However, the XL formulation lasts longer in the body than the SR and IR formulations, which could be problematic regarding sleeplessness. Taking the SR or IR formulation at an earlier scheduled time can help. Ultimately, the best dosing regimen involves an individualized approach to each person’s needs. 

Practicing good sleep hygiene can also help. Avoid caffeine or stimulants in the afternoon, go to bed at the same time each night, turn off the lights, and avoid other distractions around bedtime.

Weight changes

Ask a dietitian or nutritionist for advice if body weight goes up or down unintentionally.

Seizures

If seizures or convulsions are experienced while taking bupropion, immediately talk to the prescriber or other healthcare professional. The drug should be stopped to prevent future seizures.

Mental health changes

Call the prescriber or other healthcare professional if you experience mood changes or racing thoughts when taking bupropion. The medicine may cause it. In some cases, another drug may be prescribed in place of bupropion.

RELATED: Wellbutrin (bupropion) alternatives

Allergic reactions

A severe hypersensitivity reaction to bupropion will require immediate medical attention. Look for symptoms, such as hives, swollen face or neck, trouble breathing, wheezing, sore throat, fever, blisters, or bad skin rash.