Bupropion (Wellbutrin® SR/XL and generic forms) belongs to a group of medications called “antidepressants.”

What is this medication used for?

Bupropion is not approved by Health Canada for use in children and adolescents. However, bupropion may help treat depression, depression associated with bipolar disorder, attention-deficit/hyperactivity disorder (AD/HD), and cravings associated with quitting smoking.

When potential benefits outweigh potential risks, bupropion may be prescribed “off-label.” Learn more about off-label medication use: http://bit.ly/KMH-off-label-use

Tell your doctor or pharmacist if you:

• Have allergies or bad reactions to a medication
• Take (or plan to take) other prescription or non- prescription medications, including natural medicines. Some medications interact with bupropion. Your doctor may adjust medication doses or monitor for side effects
• Have a history (or family history) of heart, kidney or liver disease, seizures, bipolar disorder or glaucoma
• Have a history of bulimia, anorexia or problematic substance use
• Miss a menstrual period, are pregnant, breast-feeding or planning a pregnancy
• Use alcohol or street drugs. Taking bupropion together with certain substances may cause a bad reaction. Learn more at www.DrugCocktails.ca

When will the medication start to work?

You (or your family members) may notice improvements in sleep, appetite and energy within the first 2 weeks.

However, it may take 3 to 6 weeks before you begin to feel better. Full beneficial effects may take 4 to 8 weeks or longer.

If you are taking bupropion to help you quit smoking, you may start to notice reduced cravings for cigarettes within 1 week.

Bupropion takes time to work. Continue taking bupropion as prescribed, even if you are feeling better. Talk with your doctor before you increase, decrease or stop taking bupropion.

This medication is not addictive. Do not stop taking it before talking to your doctor.

How do I take this medication?

Extended-release (XL) bupropion is usually taken once daily in the morning. Sustained-release (SR) bupropion can be taken once daily in the morning or twice daily (in the morning and 8 hours later). Bupropion can be taken with or without food. Usually, you will start with a low dose and slowly increase this dose over several days to weeks, based on how you tolerate it.

Both XL and SR bupropion tablets should be swallowed whole with fluid. Do not crush, chew or divide bupropion tablets. Do not take more than your prescribed dosage of bupropion.

Possible common or serious side effects:

Side effects may be more common when starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

• Dizziness, drowsiness or headache
• Irritability or feelings of agitation
• Trouble sleeping or abnormal dreams
• Constipation, nausea or stomach ache
• Decreased appetite or weight loss
• Sweating, tremors or motor tics
• Dry mouth or ringing in the ears
• Skin rash or itchy skin
• Increased heart rate or an uncomfortable awareness of your own heart beat

Contact your doctor immediately if you experience:

• Seizures
• Thoughts of hurting yourself, hostility or suicide
• Changes in mood to an unusual state of excitement, irritability or happiness
• Uncomfortable sense of inner restlessness or agitation

What precautions should my doctor and I be aware of when taking this medication?

• Bupropion is associated with a higher risk of seizures, especially if you have (or have a history of) bulimia or anorexia nervosa. Please discuss with your doctor if you have a history of seizures, an eating disorder or problematic susbstance use, as bupropion may not be the best choice for you.
• While taking bupropion, if you feel dizzy, drowsy or slowed down, do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking bupropion.
• Do not stop taking bupropion suddenly. Stopping abruptly is associated with “antidepressant discontinuation syndrome.” This involves flu-like symptoms, trouble sleeping, nausea, irritability, headache and abnormal sensations that feel like electric shocks, burning, tingling or numbness. If stopping or changing medications, your dose should be reduced slowly.

How does this medication work?

Bupropion is a Dopamine and Norepinephrine Reuptake Inhibitor (DNRI). It increases levels of the brain chemicals dopamine and norepinephrine. These brain chemicals do not function properly in people who have depression or anxiety. The exact way that bupropion improves symptoms of depression and other conditions is not known. Bupropion may improve symptoms of ADHD by increasing dopamine and norepinephrine in areas of the brain that control impulsive actions, attention and body movements. By increasing dopamine in certain brain areas, bupropion may help reduce cravings and withdrawal when trying to quit smoking.

What special instructions should I follow while using this medication?

• Keep all appointments with your doctor and the lab.
• Your doctor may want to talk to you within 1-2 weeks of starting bupropion, and meet with you over time to make sure it is working well and check for side effects.
• Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you forget to take a dose of bupropion and the normal administration time is passed, do not try to take the missed dose. Instead, skip the missed dose and continue regularly with your next scheduled dose. DO NOT double your next dose to try to ‘catch up’.

How do I store this medication?

Keep bupropion in the original container, stored at room temperature away from moisture and heat and protected from light. Keep bupropion out of reach and sight of children.

How well does the medication work in children and adolescents?

Bupropion has not been well studied in children and adolescents for depression, depression associated with bipolar disorder or ADHD. Bupropion may be better than placebo (an inactive pill), but less effective than other treatments in reducing hyperactivity in children with ADHD. Bupropion is sometimes prescribed for children and adolescents when other treatments have not been effective. The addition of talk therapy such as Interpersonal Therapy (IPT) for depression or Cognitive Behavioural Therapy (CBT) may help increase the potential for benefit. Limited evidence suggests that bupropion is no better than other treatments alone or placebo for adolescents trying to quit smoking.

How long should I take the medication for?

This depends on the symptoms you have, how frequently they occur and how long you have had them. Most people need to take bupropion for at least 6 months. This allows time for symptoms to stabilize and function to improve. After this time, you and your doctor can discuss the benefits and risks of continuing treatment.

If you have had several episodes of severe depression and you tolerate bupropion well, you may be asked to take bupropion on an ongoing basis. Continuing treatment will significantly decrease the chance that you may have another episode of depression.

Do not increase, decrease or stop taking bupropion without discussing it with your doctor, even if you are feeling better. If you stop taking bupropion suddenly, it is possible that your symptoms may return or you may have a bad reaction.

TIP: Use the Kelty Mental Health Antidepressant Monitoring Form for Children and Adolescents to help measure your progress on this medication: https://keltymentalhealth.ca/r/antidepressant-monitoring-form