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What
is Wellbutrin?
Wellbutrin (bupropion) and Wellbutrin SR, manufactured by
GlaxoSmithKline, are medications approved by the FDA for the
treatment of depression. Wellbutrin has also been used in
an off-label capacity (not specifically approved for, but
observed to be effective) to treat attention-deficit/hyperactivity
disorder (AD/HD) and seasonal affective disorder (SAD), and
to decrease the sexual side effects caused by other antidepressants.
Bupropion, the chemical name for this medication, is additionally
sold under the brand name Zyban to help stop the urge to smoke.
How
is Wellbutrin different from other antidepressants?
Wellbutrin has a chemical structure unrelated to any other
antidepressant medication. Unlike some of the other recently
developed antidepressants (i.e., Celexa, Paxil, Prozac, and
Zoloft) that target the brain chemical serotonin, Wellbutrin
does not affect serotonin. Although not known for sure, it
may act on the brain chemicals dopamine and norepinephrine.
Because of its unique makeup, Wellbutrin also has different
side effects, and it may work for individuals who have not
had success with other antidepressants.
What
are the side effects of Wellbutrin?
Fewer sexual side effects and weight gain are associated with
Wellbutrin as well as fewer reports of anticholinergic symptoms
(blurred vision, dry mouth, indigestion, and constipation),
cardiac problems, and orthostatic hypotension (low blood pressure
occurring after standing up).
There has been
much talk about Wellbutrin causing seizures. In fact, the
approval of Wellbutrin was temporarily delayed due to the
occurrence of seizures in some patients. However, further
investigation showed that seizures were primarily associated
with high doses (above the current maximum recommended dose
of 450 mg/day), a history of seizures or brain trauma, an
eating disorder, excessive alcohol use, or taking other drugs
that can also increase the risk for seizures. With new warnings
and lower recommended doses, the chance of having seizures
has been greatly reduced.
Among the other
common side effects of Wellbutrin are restlessness, insomnia,
headache or a worsening of preexisting migraine conditions,
tremor, dry mouth, agitation, confusion, rapid heartbeat,
dizziness, nausea, constipation, menstrual complaints, and
rash.
How
does Wellbutrin interact with other medications?
Wellbutrin and Zyban should not be taken together as they
contain the same active ingredient, which could cause seizures
if too much is taken. There are also other medications that
make some people more likely to have seizures, so be sure
to tell your doctor what drugs you are on before taking Wellbutrin.
Withdrawal from alcohol or some street drugs while taking
Wellbutrin can additionally increase the chance of having
seizures.
It
is also recommended that care be taken when combining Wellbutrin
with the anticonvulsant medications Dilantin (phenytoin),
Tegretol (carbamazepine), or phenobarbital or with the ulcer
medication Tagamet (cimetidine). These particular drugs can
cause changes in the way the body uses or reacts to Wellbutrin.
(Tegretol is frequently used to treat bipolar disorder [manic
depression].) People taking any medications containing L-Dopa,
primarily people with Parkinson’s disease, have reported
stronger side effects from taking Wellbutrin. And you should
not take Wellbutrin when taking the antidepressant medications
called monoamine oxidase inhibitors (MAOIs).
What
is the recommended dose of Wellbutrin?
Wellbutrin is available in both standard 75 mg and 100 mg
tablets, and in 100 mg, 150 mg, and 200 mg sustained-release
tablets. Because Wellbutrin could cause seizures in some people,
your doctor will carefully and gradually increase your dose.
The recommended beginning dose for the drug is 100 mg/day
twice daily. Your doctor should not increase this starting
dose until after at least the first three days of treatment.
Once the first few days have passed, the typical dose for
Wellbutrin is 300 mg/day—100 mg three times daily, with
at least six hours between doses, for the standard tablets
and 150 mg twice daily for the sustained-release tablets.
The maximum recommended daily dose for the drug is 450 mg.
Sustained-release Wellbutrin, or Wellbutrin SR, should be
taken whole—not chewed, crushed, or broken—so
that the body correctly absorbs it. Elderly individuals taking
Wellbutrin are usually prescribed smaller doses of the medication.
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