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Wellbutrin side effects and how to avoid them

Wellbutrin treats major depressive disorder (MDD), seasonal affective disorder (SAD), and assists with smoking cessation

Wellbutrin side effects | Serious side effects | Suicide | Angle-closure glaucoma | Neuropsychiatric events | Weight loss | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Wellbutrin (bupropion hydrochloride) is a brand-name prescription drug used for the treatment of major depressive disorder (MDD), the prevention of seasonal affective disorder (SAD), and smoking cessation, in addition to several off-label uses. As an antidepressant medication, Wellbutrin works by increasing the amount of norepinephrine and dopamine in the brain. These substances are neurotransmitters that are involved with regulating mood, emotions, memory, and motivation, and by increasing the levels of these neurotransmitters, Wellbutrin can help manage mental health conditions.

Brand-name Wellbutrin is available as a sustained-release (Wellbutrin SR) or extended-release (Wellbutrin XL) tablet, and generic Wellbutrin is available as an immediate-release tablet in addition to a sustained- or extended-release tablet. Bupropion might also be sold under other brand names including Forfivo XL and Aplenzin (bupropion hydrobromide), as well as Zyban, which has recently been discontinued. Although Wellbutrin works differently than other antidepressants, it does have side effects and may not be suitable for some people with pre-existing medical conditions. 

RELATED: What is Wellbutrin?

Common side effects of Wellbutrin

The most common side effects of Wellbutrin are:

  • Trouble sleeping
  • Headache
  • Agitation
  • Dry mouth
  • Constipation
  • Weight loss or weight gain
  • Migraine
  • Nausea
  • Vomiting
  • Excessive sweating
  • Tremor
  • Dizziness
  • Blurred vision
  • Fast heartbeat 
  • Joint aches
  • Sore throat

Serious side effects of Wellbutrin

Possible side effects of Wellbutrin that can be serious or even life-threatening include:

  • Worsened depression
  • Suicidal thoughts and behaviors
  • Homicidal thoughts
  • Neuropsychiatric events (psychosis, mania, hallucinations, and panic attacks)
  • Seizures
  • Severe high blood pressure (hypertension)
  • Heart problems, including irregular heartbeat 
  • Angle-closure glaucoma
  • Liver problems
  • Visual problems, such as changes in vision
  • Severe allergic reactions

Wellbutrin and suicide

Wellbutrin has a black box warning that highlights a risk of worsening depression and suicidal thoughts or behaviors in children, teens, and young adults. The incidence of these adverse effects is between 0.1% and 1%, although older adults are at a lower risk of this effect. Patients and caregivers should watch behavior and mood closely and call a healthcare provider at any signs of suicidality, such as:

  • Talks of suicide or dying
  • Suicide attempts
  • New or worsened depression, anxiety, or irritability
  • Agitation and restlessness
  • Extreme dietary changes
  • Irritability
  • Trouble sleeping
  • Increased use of illicit substances or alcohol
  • Unusual, aggressive, or violent behaviors
  • Isolation from friends and family

Wellbutrin and angle-closure glaucoma

Angle-closure glaucoma is a medical emergency that comes on suddenly when the opening, or angle, between the iris and the cornea is blocked, causing fluid pressure to build up rapidly in the eye. This opening allows fluid to drain from the eye, but people with uncorrected “narrow angles” between the iris and the cornea are particularly vulnerable to closure. Because angle-closure glaucoma can rapidly develop into permanent vision loss, you should immediately stop taking Wellbutrin and go to an emergency room at any sign of angle-closure glaucoma, such as:

  • Eye pain
  • Changes in vision
  • Swelling or redness in or around the eye

Wellbutrin and neuropsychiatric events

When taken for smoking cessation, Wellbutrin has been reported to cause neuropsychiatric events, such as depression, anxiety, panic attacks, hostility, and even psychosis or hallucinations. The risk of experiencing these events can vary, but people with a history of mental health problems may be at a high risk of experiencing these events. Patients and caregivers should monitor behaviors and mood closely and call a healthcare provider at any sign of psychiatric problems. 

Wellbutrin and weight loss

Weight loss is a common side effect of Wellbutrin, affecting 14% to 23% of people who take the medication. Anorexia—loss of appetite—is also commonly experienced, with an incidence between 1% and 18%. For this reason, some healthcare professionals may prescribe bupropion off-label for weight loss or weight loss maintenance, while others consider it the antidepressant of choice for patients diagnosed with both depression and obesity. The U.S. Food and Drug Administration (FDA) has approved at least one bupropion drug for weight loss: Contrave, a combination of bupropion and naltrexone, a drug normally used to treat opioid or alcohol abuse.

How long do side effects last?

With a half-life of 14 hours when taken as a single dose and 21 hours when taken on a consistent basis, bupropion and its active metabolites can remain in the body for three or four days. However, side effects are usually mild and temporary. Side effects of bupropion can last a couple of days or weeks as the body gets used to the drug. Consult a healthcare provider if side effects last longer than two to three weeks, or if side effects are particularly bothersome or severe.

Some side effects may take longer to resolve or require medical attention. Serious adverse effects, such as severe allergic reactions, angle-closure glaucoma, irregular heartbeat, heart attack, seizures, severe high blood pressure, and severely low blood sodium levels will require medical attention. Some of these side effects, such as angle-closure glaucoma or heart attack, may have lifelong complications.

Suicidality, worsening of depression, mood changes, mania, hostility, and other neuropsychiatric events can occur with the use of bupropion. In many cases, Wellbutrin will be discontinued. However, these symptoms may be due to pre-existing mental health problems, so long-term psychiatric treatment for other mental health problems may be recommended.

Wellbutrin contraindications & warnings

Wellbutrin affects the brain and body in different ways, and it can cause problems in people with a variety of pre-existing conditions. 

Abuse and dependence

The U.S. Food and Drug Administration (FDA) does not consider Wellbutrin a drug that can cause physical dependence, abuse, or tolerance. However, Wellbutrin can produce a mild amphetamine-like reaction. For this reason, Wellbutrin is commonly abused as a street drug and sometimes referred to as “the poor man’s cocaine.” This medication also carries a risk for psychological dependence, but the most serious problems are side effects, particularly seizures, when people abuse bupropion by snorting the drug, injecting the drug, or taking it in large doses.

Overdose

A Wellbutrin overdose is potentially serious and will often require medical attention. The most common side effect of a Wellbutrin overdose is seizures, but other symptoms include:

  • Hallucinations
  • Loss of consciousness
  • Fast heartbeat
  • Irregular heartbeat
  • Overactive reflexes
  • Convulsions

When taken in excessive amounts in combination with other drugs, Wellbutrin may also cause fever, muscle rigidity, low blood pressure, stupor, coma, and respiratory failure.

Restrictions

Some medical conditions make taking Wellbutrin too hazardous:

  • Anyone with allergies to bupropion will not be prescribed Wellbutrin. 
  • Because of an increased risk of seizures, Wellbutrin is never given to people with a history of seizures, a prior diagnosis of an eating disorder, such as anorexia or bulimia, or anyone undergoing abrupt withdrawal from alcohol, barbiturates, benzodiazepines, or antiepileptic medications.

Other pre-existing conditions may cause problems, so healthcare providers will prescribe Wellbutrin cautiously and watch carefully for side effects. 

  • Because of the increased risk of suicidal thoughts and behaviors, people younger than the age of 25 should be carefully watched for signs of worsening depression, unusual behaviors, or thoughts about suicide or dying. Any mood changes, depression, or suicidality need to be reported to the prescribing healthcare professional as soon as they’re noticed.
  • Because of an increased risk for seizures, people with risk factors for seizures may need to be carefully monitored. These risk factors include head injury, CNS infection, severe stroke, arteriovenous malformation, and drug or alcohol abuse. 
  • People with a history of mental health problems will be monitored for neuropsychiatric side effects, particularly when taking Wellbutrin for smoking cessation.
  • All antidepressants can provoke mania or hypomania in people with bipolar disorder, so people with bipolar disorder should be closely monitored for behavioral changes.
  • People with high blood pressure or a recent heart attack may require close monitoring of blood pressure. 
  • People who have uncorrected narrow angles are at a higher risk of narrow-angle glaucoma when taking Wellbutrin, so they should watch for and report any eye problems.
  • People with Tourette’s syndrome or with a tic disorder may be at risk for new or worsening tics when taking Wellbutrin.
  • Wellbutrin may require dose modifications and monitoring in people with liver or kidney problems

Pregnancy and nursing

There is no evidence that bupropion increases the risk of birth defects, miscarriage, or other problems when taken during pregnancy. Because untreated depression does have pregnancy risks, women should get medical advice from a healthcare professional about the safety and benefits of taking Wellbutrin during pregnancy.

Nursing mothers are advised to be cautious about taking Wellbutrin. Bupropion and its active metabolites are present in breast milk, but healthcare providers are uncertain about its effects on the baby. Before taking Wellbutrin, women who are breastfeeding should talk to a healthcare professional about its benefits and risks.

Children

The Food and Drug Administration (FDA) has not approved bupropion for anyone younger than the age of 18. Some healthcare providers, however, may prescribe Wellbutrin off-label to children as young as 11 years of age, but these children are at an increased risk of worsening depression, suicidal thoughts, and suicidal behaviors.

Seniors

People older than 65 can take Wellbutrin in the same doses as younger adults, but doses may be modified in some older adults if the person has liver or kidney problems.

Wellbutrin interactions

Most Wellbutrin drug interactions are minor, but some are serious enough to require monitoring, dosing changes, or avoiding the drug combination altogether.

Wellbutrin is never combined with some drugs because of the potential hazards. These include:

  • MAO inhibitors: Because of the risk for high blood pressure or seizures, Wellbutrin is never taken with monoamine oxidase inhibitors (MAOIs), a small family of drugs that includes the antidepressants isocarboxazid, phenelzine, tranylcypromine, and selegiline. Other examples of MAOIs include the cancer drug procarbazine, the antibiotic linezolid, and methylene blue injections.
  • Anti-seizure medications, barbiturates, and benzodiazepines: Because of an increased risk of seizures, treatment with Wellbutrin is not started if these medications have been used excessively or discontinued suddenly.
  • Other precautions: Because of the increased risk of serious heart rhythm problems, Wellbutrin is not recommended to be taken with the antipsychotic drugs pimozide or thioridazine.

Some drugs that lower the seizure threshold may need to be avoided. These include:

Bupropion raises dopamine levels in the brain. When combined with similar drugs (dopaminergic drugs), dopamine can rise to toxic levels. So both levodopa and amantadine should be used cautiously with bupropion.

Bupropion can block the body’s metabolism of other drugs. As a result, the concentration of other drugs in the body can increase, raising the risk of side effects. Either these drugs must be stopped or the doses must be changed. These include:

  • Tricyclic antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs
  • Antipsychotics 
  • Beta blockers
  • Certain types of heart rhythm medications

Finally, alcohol mixed with bupropion can provoke neuropsychiatric events. The use of alcohol should be avoided or minimized when taking Wellbutrin.

How to avoid Wellbutrin side effects

1. Take Wellbutrin as directed

Take Wellbutrin as instructed. The typical dose is 300 mg a day. Don’t skip a dose, but if you do, don’t make up that dose. Wait until the next scheduled dose and take that dose as planned.

2. Tell the healthcare provider about all medical conditions

To avoid potentially serious side effects, tell the prescribing healthcare professional about all medical conditions, especially if you’ve had a history of:

  • Eating disorders
  • Suicide attempts
  • Depression or other mental health problems, such as mania, hypomania, or bipolar disorder
  • Heart disease, high blood pressure, or recent heart attack
  • Liver problems
  • Kidney problems
  • Head injuries
  • Seizures
  • Brain or spinal tumors
  • Diabetes
  • Alcohol or illicit drug use
  • Pregnancy or pregnancy plans
  • Breastfeeding or plans to breastfeed

3. Tell the healthcare provider about all medications

Drug interactions can also cause side effects, so tell your healthcare provider about all prescription and over-the-counter medications you take, especially:

4. Do not drink alcohol

Drinking alcohol when being treated with Wellbutrin can cause neuropsychiatric side effects. Avoid alcohol entirely or drink in moderation according to your doctor’s instructions.

5. Be careful about driving and other risky activities at first

Avoid driving cars or operating machinery for a few days until you’re familiar with Wellbutrin and how it affects your body.

6. Eat a healthy diet

To avoid weight loss or weight gain, eat a healthy diet and carefully monitor weight while taking Wellbutrin. A dietitian or nutritionist may be able to help if appetite and weight changes become a problem while taking this medication.

7. Talk to a healthcare provider before discontinuing Wellbutrin

The sudden discontinuation of Wellbutrin can cause unpleasant withdrawal effects. Seek medical advice if Wellbutrin does not seem to be working or the side effects become hard to manage. Upon discontinuing Wellbutrin, a healthcare provider may recommend tapering, or gradually lowering, the dose to help prevent problems when stopping Wellbutrin.

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