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Wellbutrin

Generic name:
Brand names: Wellbutrin XL, Wellbutrin SR, Wellbutrin

Why is Wellbutrin prescribed?

Wellbutrin is prescribed to help relieve major depression. Symptoms include a severely depressed mood (for 2 weeks or more) and loss of interest or pleasure in usual activities accompanied by sleep and appetite disturbances, agitation or lack of energy, feelings of guilt or worthlessness, decreased sex drive, inability to concentrate, and sometimes, suicidal thoughts or behavior.

Wellbutrin is thought to work by altering levels of the brain chemicals norepinephrine and dopamine. It is not chemically related to other antidepressants such as tricyclics (Elavil), MAO inhibitors (Nardil, Parnate), or serotonin re-uptake inhibitors (Paxil and Prozac).

Most important fact about Wellbutrin

Wellbutrin is associated with an increased risk of seizures. This risk is greater at higher doses (approximately 4 in 1,000 patients at dosages of 300 to 450 milligrams a day). Certain factors increase the risk of seizure, including:

A history of head trauma or previous seizure
Central nervous system tumor
Severe liver disease such as cirrhosis
A history of eating disorders, including anorexia and bulimia
Excessive use of alcohol, or abrupt withdrawal from alcohol or sedatives
Taking medications that lower the seizure threshold (see "Possible food and drug interactions when taking Wellbutrin")

To minimize the risk of seizures, dose increases should be done gradually, and the total daily dose of Wellbutrin should not exceed 450 milligrams. Additionally, the doctor should be aware of all your medical conditions, and you should not take any other medications (both prescription and over-the-counter) unless the doctor approves.

How should you take Wellbutrin?

Take Wellbutrin exactly as prescribed by your doctor. The usual dosing regimen is 3 equal doses spaced evenly throughout the day. Allow at least 6 hours between doses. Your doctor will probably start you at a low dosage and gradually increase it; this helps minimize side effects.

You should take Wellbutrin SR, the sustained-release form, in 2 doses, at least 8 hours apart. Wellbutrin XL extended-release tablets should be taken once a day in the morning. Swallow Wellbutrin SR and Wellbutrin XL tablets whole; do not chew, divide, or crush them.

If Wellbutrin works for you, your doctor will probably have you continue taking it for at least several months.

--If you miss a dose...

Take it as soon as you remember. If it is within 4 hours of your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.

--Storage instructions...

Store at room temperature. Protect from light and moisture.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Wellbutrin.

• Side effects of Wellbutrin may include:
  Agitation, constipation, dizziness, dry mouth, excessive sweating, headache, nausea, vomiting, skin rash, sleep disturbances, tremor

• Side effects of Wellbutrin SR may include:
  Agitation, constipation, dizziness, dry mouth, insomnia, nausea, rash, sweating, weight loss

• Side effects of Wellbutrin XL may include:
  Abdominal pain, agitation, anxiety, constipation, diarrhea, dizziness, dry mouth, heart palpitations, increased urination, insomnia, muscle soreness, nausea, rash, ringing in the ears, sore throat, sweating

Why should Wellbutrin not be prescribed?

Do not take Wellbutrin if you are sensitive to or have ever had an allergic reaction to it.

Since Wellbutrin causes seizures in some people, do not take it if you have any type of seizure disorder or if you are taking another medication containing bupropion, such as Zyban, the used to help quit smoking. If you have a seizure while taking Wellbutrin, stop taking the drug and never take it again.

Do not take Wellbutrin while abruptly giving up alcohol or sedatives, including tranquilizers such as Librium, Valium, and Xanax. Rapid withdrawal increases the risk of seizures.

If you have had any kind of heart trouble or liver or kidney disease, be sure your doctor knows about it before you start taking Wellbutrin. It must be used with extreme caution if you have severe cirrhosis of the liver. A reduced dosage may be needed if you have any sort of liver or kidney problem.

You should not take Wellbutrin if you currently have, or formerly had, an eating disorder. For some reason, people with a history of anorexia nervosa or bulimia seem to be more likely to experience Wellbutrin-related seizures. Do not take Wellbutrin if, within the past 14 days, you have taken a monoamine oxidase inhibitor (MAO inhibitor) drug, such as the antidepressants Marplan, Nardil or Parnate. This particular drug combination could cause you to experience a sudden, dangerous rise in blood pressure.

Special warnings about Wellbutrin

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Wellbutrin or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Wellbutrin has not been studied in children or adolescents and is not approved for treating anyone less than 18 years old.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Wellbutrin and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Be sure to let the doctor know if you have heart trouble, liver problems, or kidney disease before you start taking Wellbutrin. Use Wellbutrin with extreme caution if you have cirrhosis of the liver.

Stop taking Wellbutrin and call your doctor immediately if you have difficulty breathing or swallowing; notice swelling in your face, lips, tongue, or throat; develop swollen arms and legs; or break out with itchy eruptions. These are warning signs of a potential severe allergic reaction.

Wellbutrin may affect your coordination or judgment and impair your ability to drive or operate dangerous machinery. Avoid activities that require full alertness until you know how the drug affects you.

Like all antidepressants, Wellbutrin could trigger a manic episode in people with bipolar disorder.

Although Wellbutrin occasionally causes weight gain, a more common effect is weight loss: Some 28 percent of people who take Wellbutrin lose 5 pounds or more. If depression has already caused you to lose weight, and if further weight loss would be detrimental to your health, Wellbutrin may not be the best antidepressant for you.

Possible food and drug interactions when taking Wellbutrin

Do not drink alcohol while you are taking Wellbutrin; an interaction between alcohol and Wellbutrin could increase the possibility of a seizure.

Wellbutrin should not be combined with drugs that lower the seizure threshold, including:

Antidepressants classified as MAO inhibitors, such as Nardil and Parnate
Other antidepressants such as Elavil, Norpramin, Pamelor, Paxil, Prozac, Tofranil, and Zoloft
Antipsychotic drugs such as Haldol, Risperdal, Mellaril, and chlorpromazine
Cocaine
Diabetes medications such as Glucotrol and Prandin
Insulin
Opiates such as heroin and morphine
Sedatives, including benzodiazepines such as Xanax and Valium
Steroid medications such as prednisone
Stimulants, including over-the-counter diet drugs
Theophylline (Theo-24, Uniphyl)

If Wellbutrin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Wellbutrin with the following:

Beta blockers (used for high blood pressure and heart conditions) such as Inderal, Lopressor, and Tenormin
Carbamazepine (Tegretol)
Cimetidine (Tagamet)
Cyclophosphamide (Cytoxan)
Heart-stabilizing drugs such as Rythmol and Tambocor
Levodopa (Larodopa)
Nicotine patches such as Habitrol, NicoDerm CQ, and Nicotrol patch
Orphenadrine (Norgesic)
Phenobarbital
Phenytoin (Dilantin)

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, notify your doctor immediately. Wellbutrin should be taken during pregnancy only if clearly needed.

Wellbutrin does pass into breast milk and may cause serious reactions in a nursing baby; therefore, if you are a new mother, you may need to discontinue breastfeeding while you are taking Wellbutrin.

Recommended dosage

No single dose of Wellbutrin should exceed 150 milligrams.

ADULTS

Wellbutrin

At the beginning, your dose will probably be 200 milligrams per day, taken as 100 milligrams 2 times a day. After at least 3 days at this dose, your doctor may increase the dosage to 300 milligrams per day, taken as 100 milligrams 3 times a day, with at least 6 hours between doses. This is the usual adult dose. The maximum recommended dosage is 450 milligrams per day taken in doses of no more than 150 milligrams each.

Wellbutrin SR

The usual starting dose is 150 milligrams in the morning. After 3 days, if you do well, your doctor will have you take another 150 milligrams at least 8 hours after the first dose. It may be 4 weeks before you feel the benefit and you will take the drug for several months. The maximum recommended dose is 400 milligrams a day, taken in doses of 200 milligrams each.

If you have severe cirrhosis of the liver, your dosage should be no more than 75 milligrams once a day. With less serious liver and kidney problems, the dosage will be reduced as needed.

Wellbutrin XL

The usual starting dose is 150 milligrams taken once a day in the morning. If this dose is well tolerated after a minimum of 3 days, the doctor may increase the dose to 300 milligrams, also taken once a day in the morning. If no improvement is seen after several weeks of treatment, the doctor may increase the dose to a maximum of 450 milligrams once a day.

If you have severe liver damage, use Wellbutrin with extreme caution. Your dose should not exceed 150 milligrams every other day. People with mild to moderate liver damage or kidney impairment will be prescribed a lower dose as well.

CHILDREN

The safety and effectiveness in children under 18 years old have not been established.

Overdosage

There have been rare reports of death after an overdose of Wellbutrin. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Wellbutrin overdose may include:
  Hallucinations, heart failure, loss of consciousness, rapid heartbeat, seizures

• Symptoms of Wellbutrin SR overdose may include:
  Blurred vision, confusion, jitteriness, lethargy, light-headedness, nausea, seizures, vomiting

• An overdose that involves other drugs in combination with Wellbutrin may also cause these symptoms:
  Breathing difficulties coma fever rigid muscles stupor