How does this medication work? What will it do for me?

Bupropion belongs to the family of medications known as antidepressants. It is used to treat major depression and to prevent autumn-winter seasonal depression. It is believed to work by affecting the balance of noradrenaline and dopamine, chemicals that occur naturally in the brain and affect mood.

For the treatment of depression, the full effects of the medication may not be seen until after several weeks of treatment.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Mylan-Bupropion XL is no longer being manufactured for sale in Canada. For brands that may still be available, search under bupropion. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The recommended starting dose of bupropion extended-release tablets for treatment of major depressive disorder is 150 mg daily, taken in the morning. This dose may be increased to 300 mg daily after 1 week at the lower dose.

For prevention of seasonal depression, this medication should be started in the autumn before symptoms of depression develop and continued through the winter. The usual starting dose is 150 mg taken once daily in the morning. It may be increased to 300 mg taken once daily after 1 week at the lower dose. For people taking 300 mg daily, the dose should be reduced to 150 mg daily for 2 weeks prior to stopping this medication in the spring.

Bupropion extended-release tablets should be swallowed whole with fluids. They should not be chewed, crushed, or halved, as this may affect how this medication is absorbed by the body and result in unwanted side effects.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to bupropion or to any of the ingredients of the medication
  • are having abrupt withdrawal issues from alcohol, benzodiazepines (e.g., diazepam, clonazepam, lorazepam) or other sedatives (e.g., phenobarbital)
  • are taking another medication that contains bupropion (e.g., Zyban® or Wellbutrin® SR)
  • have a seizure disorder or a history of seizures
  • have or have had an eating disorder (bulimia or anorexia nervosa)
  • have taken a monoamine oxidase inhibitor (MAOI; e.g., phenelzine, tranylcypromine) within the last 14 days
  • have taken thioridazine (an antipsychotic medication) within the last 14 days

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abnormal dreams
  • acne
  • appetite changes
  • bloating
  • changed sense of taste
  • constipation
  • dizziness
  • dryness of mouth
  • gas
  • headache
  • hot flushes
  • increased thirst
  • muscle spasms
  • nausea
  • shakiness or tremor
  • stuffy nose
  • trouble sleeping
  • weight changes

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • aggression
  • agitation
  • anxiety
  • false beliefs that cannot be changed by facts
  • feeling jittery
  • hallucinations (seeing, hearing, or feeling things that are not actually there)
  • inability to urinate
  • increased blood pressure
  • low sodium levels in the blood (e.g., tiredness; weakness; confusion; with achy, stiff, or uncoordinated muscles)
  • memory problems
  • new or worsened emotional or behavioural problems
  • painful menstrual periods
  • panic attacks
  • ringing in the ears
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, skin itching, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • symptoms of glaucoma (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
  • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
  • symptoms of mania (e.g., elevated or irritable mood, talking fast, risk taking, decreased need for sleep, racing thoughts)
  • red, thick scaly skin rash, hives or itching

Seek immediate medical attention if any of the following occur:

  • seizures (convulsions)
  • signs of a serious allergic reaction (i.e., hives, blistering skin rash, difficulty breathing, fainting, severe muscle or joint pain, or swelling of the face and throat)
  • symptoms of serotonin toxicity (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
  • thoughts of harming yourself or others

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Cutaneous lupus erythematosus (CLE): Bupropion has been associated with CLE; an autoimmune disease similar to systemic lupus erythematosus. In this condition, the immune system attacks the skin cells, causing red, thick, scaly skin rashes. Sores that burn or itch may also be formed. Contact your doctor immediately if you notice any of these changes to your skin.

Drowsiness/reduced alertness: Bupropion may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.

Glaucoma: This medication may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking this medication.

Heart disease: It is not known whether bupropion is safe for use by people with a recent history of heart attack or unstable heart disease. Bupropion may cause increases in blood pressure. If you have heart problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Identical medications: Wellbutrin® XL, Wellbutrin® SR, Zyban®, and several other medications contain the same active ingredient (bupropion). If you are taking one of these medications, do not take the other or any other product containing bupropion, as the risk of seizures increases with an increased dosage. To reduce the risk of seizures, the total daily dose of this medication should not be greater than 300 mg.

Kidney function: Bupropion is removed from the body by the kidneys. Decreased kidney function can cause this medication to build up in the body, causing side effects. If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Bupropion is removed from the body by the liver. Decreased liver function can cause this medication to build up in the body, causing side effects. If you have liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

This medication may also cause a decrease in liver function. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Seizure risk: This medication may increase the risk of seizures.  If you are at risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Things which increase the risk of seizures include:

  • addiction to cocaine, stimulants (e.g., amphetamines), or opiates (e.g., morphine, codeine, oxycodone)
  • diabetes treated with oral medications or insulin
  • excessive alcohol use
  • history of head trauma or seizures (including epilepsy)
  • severe liver problems
  • tumours of the brain or spinal cord
  • use of other medications that make seizures more likely (e.g., antipsychotics, antidepressants, lithium, theophylline, steroids)
  • use of over-the-counter stimulants or appetite suppressants

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor first.

Serotonin syndrome: Severe reactions are possible when bupropion is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, other medications used to treat depression. Similar effects occur when too much bupropion is taken or is allowed to build up in the body. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. These reactions should be treated as a medical emergency and immediate medical treatment should be obtained as coma and death are possible.

Suicidal or agitated behaviour, or other behaviour changes: Especially in the first few weeks or when doses are changed, a small number of people may feel worse instead of better when taking this medication. People may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. Your doctor will monitor you closely for these side effects while you are taking this medication.

Pregnancy: This medication should not be taken during pregnancy unless the benefits outweigh the risks. It has been reported that babies born to pregnant people who have taken medications of this kind during pregnancy may be adversely affected. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Bupropion passes into breast milk. Because this medication presents risks to breast-feeding infants, a decision should be made whether to discontinue breast-feeding or to discontinue bupropion, taking into account the importance of the medication to the parent. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using bupropion have not been established for children and adolescents under 18 years of age. The use of this medication in children under 18 may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

Seniors: Because this medication is removed from the body by the kidneys and liver, seniors may be at an increased risk of side effects, including seizures, if they use this medication. If you are over 65, discuss with your doctor whether any special monitoring is required.

What other drugs could interact with this medication?

There may be an interaction between bupropion extended-release tablets and any of the following:

  • alcohol
  • amphetamines (e.g., amphetamine, dextroamphetamine, lisdexamfetamine)
  • anti-Parkinson medications (e.g., amantadine, apomorphine, bromocriptine, levodopa, pramipexole, ropinirole, rotigotine)
  • antipsychotics (e.g., aripiprazole, cariprazine, chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • atomoxetine
  • beta-blockers (e.g., metoprolol, propranolol, timolol)
  • caffeine
  • carbamazepine
  • chlorpheniramine
  • clopidogrel
  • codeine
  • dextromethorphan
  • digoxin
  • doxorubicin
  • duloxetine
  • efavirenz
  • eliglustat
  • fesoterodine
  • flecainide
  • galantamine
  • gefitinib
  • hydrocodone
  • iodinated contrast agents
  • lemborexant
  • levodopa
  • linezolid
  • lumacaftor and ivacaftor
  • meperidine
  • methylphenidate
  • metoclopramide
  • mexiletine
  • mifepristone
  • monoamine oxidase inhibitors (MAOI; e.g., phenelzine, tranylcypromine, moclobemide, rasagiline, selegiline) – bupropion should not be started until at least 14 days after MAO inhibitors are stopped
  • nevirapine
  • nirmatrelvir and ritonavir
  • ozanimod
  • polyethylene glycol electrolyte solution
  • phenobarbital
  • phenytoin
  • pitolisant
  • primidone
  • propafenone
  • rifampin
  • ritonavir
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, escitalopram, fluoxetine, paroxetine, sertraline, vortioxetine)
  • tamoxifen
  • tamsulosin
  • tetrabenazine
  • theophylline
  • tolterodine
  • tramadol
  • vilazodone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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