Wellbutrin XL

Wellbutrin is the brand name for the antidepressant medication with the active ingredient Bupropion. It comes in 150 mg and 300 mg extended-release tablets. Wellbutrin works as an NDRI, boosting brain chemicals norepinephrine and dopamine to improve mood. The typical starting dose of Wellbutrin is 150 mg, and after four days, the dosage may be increased to 300 mg, taken once daily in the morning. It is a prescription drug; you can’t buy Wellbutrin if your doctor has not recommended it to you. Common side effects include headaches and sweating, with serious side effects like seizures being rare. Wellbutrin shouldn’t be mixed with certain medications, including MAOIs, and requires careful monitoring for mood changes and other potential side effects. Follow all the guidelines provided by your doctor to use it safely.

Wellbutrin XL is prescribed to manage major depressive disorder (MDD) and seasonal affective disorder (SAD), available in 150 mg and 300 mg oral extended-release tablets. As a Norepinephrine/Dopamine Reuptake Inhibitor (NDRI), it differs from traditional antidepressants by specifically increasing levels of norepinephrine and dopamine in the brain, thereby enhancing mood and emotional well-being. Patients typically start with a 150 mg dose, increasing to 300 mg based on their response and health condition. It is essential to take the medication in the morning, with or without food, and to swallow the tablets whole without crushing or dividing them.

Dosage adjustments are necessary for individuals with hepatic or renal impairment to avoid adverse effects. Missing a dose should not lead to doubling up; instead, continue with the next scheduled dose to prevent overdose risks such as seizures or hallucinations. The common side effects include headaches, sweating, changes in libido, and digestive issues, usually diminishing over time. However, severe side effects like seizures, manic episodes, and severe allergic reactions require immediate medical attention.

Wellbutrin carries the highest FDA warning due to the risk of mood and behavior changes, including suicidal thoughts, particularly in younger populations. It is contraindicated with MAOIs and requires caution when used with other medications affecting brain chemistry. Regular monitoring by healthcare professionals is advised to manage side effects and adjust dosages appropriately. Wellbutrin’s interaction with alcohol and certain drugs, its effect on pregnancy and breastfeeding, and its potential impact on various health conditions highlight the importance of medical supervision during treatment.

Wellbutrin XL can only be used to:

• Treat major depressive disorder (MDD)
• Prevent seasonal affective disorder

It comes in the form of oral extended-release tablets and has two strengths:

• Wellbutrin 150 mg
• Wellbutrin 300 mg

Recommended Dosage For Different Treatments

For Major Depressive Disorder (MDD): It is advised to start with a dose of 150 mg taken each morning. After taking this dose for four days, it can be increased to 300 mg every morning.

For Seasonal Affective Disorder (SAD): The initial dose is also 150 mg once a day. After seven days, this dose may be raised to 300 mg daily (in the morning).

• It should be swallowed whole and not divided, crushed, or chewed.
• It should be taken in the morning daily as prescribed.
• It can be taken with or without food.

Dosage Adjustment

In Patients with Hepatic Impairment

For individuals with moderate to severe liver conditions (measured by a Child-Pugh score of 7 to 15), the highest amount of medication they should take is 150 mg every other day. For those with a mild liver condition (Child-Pugh score of 5 to 6), it may be necessary to lower the amount and/or how often the medication is taken.

In Patients with Renal Impairment

For patients with kidney conditions (specifically, when the kidney’s filtration rate is below 90 mL/min), it may be necessary to decrease the amount and/or how often Wellbutrin XL is taken.

[Note: Dosage and timing may vary depending on person-to-person. If you find something is not working for you, consult your doctor right away.]

Wellbutrin is a type of medication known as an NDRI, which stands for norepinephrine/dopamine reuptake inhibitor. It’s different from other antidepressants. It boosts the amounts of certain chemicals in the brain, specifically norepinephrine and dopamine. By increasing these chemicals, Wellbutrin can help reduce feelings of depression, including sadness, a sense of emptiness, a lack of interest in things you used to enjoy, and feelings of anxiety and stress. This process helps improve mood and emotional well-being.

Common and mild side effects of Wellbutrin can include:

• Headache
• Sweating, which may include night sweats
• Increased or decreased libido (sex drive)
• Digestive problems, such as loss of appetite, constipation, nausea, and abdominal pain
• Sleep problems, such as insomnia or sleepiness (making you tired)
• Hot flashes
• Dizziness
• Dry mouth or sore throat
• Ringing in the ears
• Heart palpitations (feeling that your heartbeat is fluttering, skipping, or racing)
• Tremor
• Muscle pain
• Changes in body weight, including weight gain and weight loss
• Skin rash
• Mild allergic reaction

Serious side effects aren’t common from Wellbutrin XL, but it’s necessary to call a doctor right away if you notice or have:

• Vision problems
• High blood pressure
• Mental health effects
• Severe allergic reaction
• Seizures
• Suicidal thoughts and behavior

[Note: Most of these side effects will disappear within a few days or a few weeks. However, if they become more severe or don’t go away, talk with a healthcare provider or pharmacist.]

Seizures: Taking this medication could lead to seizures, especially if you take higher amounts. It’s important to discuss your entire health history and any other medicines you’re using with your doctor before starting this medication. Some health conditions and medications can make seizures more likely when you’re taking this drug. To lower the risk of seizures, your doctor might gradually increase your dose.

Manic Episodes: This medication may trigger episodes of extreme mood elevation, known as mania. Signs of mania include a significant boost in energy, difficulty sleeping, very fast thoughts, or acting without thinking about the consequences. You might also experience exceptionally exciting thoughts, feel overly happy or easily annoyed, or speak more quickly than usual.

Monoamine Oxidase Inhibitors (MAOIs): Do not take Wellbutrin with this inhibitor, but if you want to continue with it, follow these instructions strictly or consult with your doctor.

Do not start treatment with Wellbutrin during the two weeks after you stop an MAO inhibitor.

Wait for at least two weeks after stopping Wellbutrin before you begin taking an MAO inhibitor. If you don’t wait and take them together, you might experience confusion, restlessness, agitation, stomach or bowel issues, a sudden rise in body temperature, very high blood pressure, or severe convulsions.

Allergic Reaction: You could have a severe allergic reaction to this medication, known as anaphylaxis, which is an emergency and needs immediate medical attention. Other allergic reaction symptoms can include:

• Rash
• Swelling of your lips or tongue
• Hives
• Itching
• Trouble breathing
• Swollen lymph glands
• Fever
• Painful sores in your mouth or around your eyes

If you develop these symptoms, contact your healthcare professional immediately. Do not take this medicine again if you’ve ever had an allergic reaction to it, as it could be fatal (cause death).

People with Certain Health Conditions: Wellbutrin can make some health conditions worse. Don’t take it if you have:

Seizure disorder

Eating disorders such as bulimia or anorexia

Bipolar disorder

Liver disease (may need to adjust doses)

Angle-closure glaucoma.

Boxed Warnings

This medication comes with very important warnings from the U.S. Food and Drug Administration (FDA), known as boxed or black box warnings. These are the highest level of warnings given by the FDA and are there to inform both doctors and patients about the serious and potentially harmful effects of the medication.

• One major concern with this medication is that it could lead to changes in a person’s behavior. This means someone taking this medication might start feeling very hostile or agitated, could become extremely sad or depressed, or might think about suicide.
• It’s important to watch children, teenagers, and young adults closely because they have a higher chance of experiencing these thoughts and behaviors when taking this medication. If you notice any new or worsening signs of these behaviors, contact a doctor immediately for close monitoring and care.

• Visit Your Doctor: It’s important to see your doctor often if you’re taking this medication. These visits will help ensure the medicine is working correctly and allow your doctor to check for any unwanted side effects.
• Don’t Mix Medications: Do not mix this medication with drugs that affect the brain. This includes allergy pills, sedatives, antidepressants, painkillers, ADHD medications, seizure medications, muscle relaxants, and some dental anesthetics.
• Sleeping Issues: Using other brain-affecting drugs with Bupropion can increase side effects like dizziness, trouble concentrating, sleepiness, and strange dreams.
• Blood Pressure Monitoring: This medication can raise your blood pressure, which might cause dizziness, headaches, or blurred vision. You may need to monitor your blood pressure at home. Contact your doctor right away if you think your blood pressure is too high.
• Kidney Problems: If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the levels of this drug in your body and cause more side effects. Your doctor may reduce your dosage of this drug or how often you are given this drug.
• Skin Reactions: Serious skin reactions can occur. Contact your doctor if you notice skin blistering, peeling, red lesions, severe acne or rash, sores, or fever and chills with this medication.
• Alertness: This medicine may affect your alertness, making you feel drowsy, dizzy, or less alert than usual. Know how this medication affects you before driving or operating machinery.
• Stopping the Medication: Do not take this medication without your doctor’s advice. Your doctor might gradually decrease your dose to reduce withdrawal symptoms like agitation, anxiety, dizziness, headaches, increased sweating, nausea, and trouble sleeping.
• Weight Monitoring: Your appetite or weight may change while taking this medication. Your doctor will likely monitor your weight regularly. 

Other Important Precautions

For Pregnant Women: This medication falls into category C for pregnancy. This means:

• Studies in animals have shown that it could harm the unborn baby when taken by the mother.
• There haven’t been enough studies in humans to know exactly how it might affect an unborn baby.
• If you are pregnant or planning to get pregnant, you should talk to your doctor. This medication should only be used if the potential benefits outweigh the risks. If you find out you are pregnant while taking this medication, contact your doctor immediately.

For Breastfeeding Women: This medication can pass into breast milk and might have negative effects on a breastfeeding baby. If you are breastfeeding, discuss with your doctor whether you should continue breastfeeding or stop taking this medication.

For Seniors & Children: Older adults may experience slower kidney function, which means your body may take longer to remove medications. Consequently, a drug could stay in your system longer, increasing the risk of side effects. Also, the safety and effectiveness of this medication in children have not been confirmed.

• If you forget or miss taking a dose of Wellbutrin XL, do not take an extra dose to catch up. Instead, wait until it’s time for your next dose. Taking more than your usual dose can lead to unwanted side effects.
• Consider using a reminder method to help ensure you remember to take your medication. This could be setting an alarm or a timer using a reminder app on your smartphone is helpful.

Taking more than the prescribed dosage of Wellbutrin XL can lead to serious side effects. Consult your doctor immediately if you notice these symptoms of an overdose, including:

• Loss of consciousness
• Irregular heart rhythm
• Seizures
• Overactive reflexes
• Hallucinations (seeing or hearing things that aren’t there)
• An overdose of Wellbutrin may lead to death in rare cases.

[Note: If you consumed more than recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]

• Store at room temperature.
• Keep out of the reach of children.
• Keep it away from freezing temperatures.

[Note: Ask your doctor any query you may have regarding storage and disposing of this medication.]

Wellbutrin Interactions

Your healthcare providers typically will not prescribe Wellbutrin with the following drugs:

• Monoamine oxidase inhibitors (MAOIs) include:
  • Zyvox (linezolid)
  • Provayblue (methylene blue)
  • Emsam (selegiline)
  • Marplan (isocarboxazid)
  • Nardil (phenelzine)
• Antiplatelet drugs include:
  • Ticlopidine
  • Plavix (clopidogrel)
• Antiviral drugs include:
  • Sustiva (efavirenz)
  • Kaletra (lopinavir)
  • Norvir (ritonavir)
• Antiseizure drugs include:
  • Phenobarbital
  • Dilantin, Phenytek (phenytoin)
  • Epitol, Tegretol, Others (carbamazepine)
• Antidepressant drugs include:
  • Lexapro (escitalopram)
  • Zoloft (sertraline)
  • Prozac (fluoxetine)
  • Cymbalta (duloxetine)
  • Paxil (paroxetine)
• Antipsychotic drugs include:
  • Thioridazine
  • Risperdal (risperidone)
  • Haldol (haloperidol)
• Heart rhythm drugs include:
  • Flecainide
  • Propafenone
  • Lanoxin (digoxin)
• Beta-blocker drugs include:
  • Lopressor, Toprol Xl (metoprolol)
  • Inderal La, Innopran Xl, Others (propranolol)
  • Bystolic (nebivolol)
• Corticosteroid drugs include:
  • Medrol (methylprednisolone)
  • Rayos (prednisone)
  • Orapred Odt, Prelone (prednisolone)
• Dopamine agonist drugs include:
  • Gocovri (amantadine)
  • Levodopa-Containing Drugs
• Cancer drug tamoxifen (Soltamox): It is used to treat certain types of cancers. When taken together with Wellbutrin, it might reduce the effectiveness of tamoxifen.
• Xanthine drug theophylline (Theo-24): This drug is used to manage asthma. If taken with Wellbutrin, it could increase the chances of experiencing seizures.

Other Interactions of Wellbutrin XL

Lab Tests

Lab tests have shown that Wellbutrin might interfere with certain urine drug tests designed to detect amphetamines like Adderall and Adderall XR. Specifically, Wellbutrin could lead to a false-positive result, meaning the test might wrongly indicate the presence of amphetamines when there are none. If you’re taking Wellbutrin and need to undergo a urine drug test for amphetamines, it’s important to inform the healthcare professional administering the test. They may opt for a different type of drug test that Wellbutrin won’t influence.

Alcohol

If you’re taking Wellbutrin, you might ask if it’s okay to drink alcohol. It’s important to know that alcohol and Wellbutrin can interact with each other. Experts advise not to drink alcohol when you’re on Wellbutrin. People have experienced changes in their mental health when they consumed alcohol while taking Wellbutrin XL. Additionally, these medications might make you more sensitive to alcohol’s effects.

[Note: Wellbutrin can interact and even reduce the effectiveness of several medications. However, it’s not known to interact with foods and other supplements. Before starting any new prescribed medications, over-the-counter drugs, or supplements during the treatment with Wellbutrin, it’s important to talk to your healthcare provider.]

• Wellbutrin SR
• Trazodone
• Abilify (aripiprazole)
• Prozac (fluoxetine)
• Pristiq (desvenlafaxine)
• Eldepryl (selegiline)
• Cymbalta (duloxetine) SNRI
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Amitriptyline HCl
• Serzone (nefazodone)
• Zoloft (sertraline)
• Viibryd (vilazodone)
• Nardil (phenelzine)
• Pamelor (nortriptyline)
• Norpramin (desipramine)
• Trintellix (vortioxetine)
• Remeron (mirtazapine)
• Anafranil (clomipramine)
• Surmontil (trimipramine)
• Celexa (citalopram)
• Protriptyline HCl
• Parnate (tranylcypromine)
• Tofranil (imipramine)

[Note: Buy these alternatives of Wellbutrin only if your doctor prescribes it. Using any of them off-label or without consulting your doctor may result in serious consequences.]

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