Bupropion XL
WELLBUTRIN XL
Pronunciation: byoo-PROE-pee-on (WEL-byoo-trin)
“Boop ropin’ Well booty”
Strong CYP2D6 inHibitor
Skinny → weight loss possible
What it isBupropion extended-release (WELLBUTRIN XL, 2003) inhibits norepinephrine and dopamine reuptake; depression and seasonal affective disorder.
Why this oneTaken once daily, it is the only antidepressant with a seasonal-affective-disorder indication (2006) while retaining an activating, sexually sparing profile.
What limits itSeizure risk and insomnia limit it; avoid in eating or seizure disorders. Strong CYP2D6 inhibition drives interactions.
FDA-approved for
- depression (2003)
- seasonal affective disorder (2006)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder | Adults | 150 mg QAM | 300 mg QD | 300 mg QD |
| Prevention of seasonal affective disorder | Adults | 150 mg QAM | 300 mg QD | 300 mg QD |
Titration MDD: after 4 days may increase to 300 mg QD; SAD: after 7 days may increase to 300 mg QD
Renal Reduce dose and/or frequency (GFR <90 mL/min)
Hepatic Moderate–severe (Child-Pugh 7–15): max 150 mg every other day; mild: reduce dose/frequency
Instructions
- Swallow whole; do not crush, divide, or chew
- Take once daily in the morning, with or without food
- On discontinuation taper 300 mg to 150 mg QD before stopping
- For SAD, initiate in autumn and taper/discontinue in early spring
Available strengths
- ER tab 150, 300 mg
- tab 75, 100 mg
Contraindications
- Seizure disorder
- Current or prior diagnosis of bulimia or anorexia nervosa
- Patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs
- Use of MAOIs (intended to treat psychiatric disorders) concomitantly with Wellbutrin XL or within 14 days of discontinuing treatment; starting Wellbutrin XL in a patient treated with reversible MAOIs such as linezolid or intravenous methylene blue is contraindicated
Cautions
- Seizure (dose-related)
- Hypertension/elevated blood pressure
- Activation of mania/hypomania
- Psychosis and other neuropsychiatric reactions
- Angle-closure glaucoma
- Neuropsychiatric adverse events in smoking-cessation use
- Hypersensitivity reactions
Adverse reactions
- Headache
- Dry mouth
- Nausea
- Insomnia
- Dizziness
- Pharyngitis
- Constipation
- Agitation
- Anxiety
- Tremor
- Sweating
- Weight loss
Pregnancy First-trimester epidemiologic data show no increased risk of congenital malformations overall
Lactation Bupropion and metabolites present in human milk; seizures reported in breastfed infants
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 150 mg | ER tab | 30 qd | $2.35 | offered |
| 300 mg | ER tab | 30 qd | $3.01 | offered |
Other forms: Bupropion (WELLBUTRIN) · Bupropion hydrobromide ER (APLENZIN) · Bupropion SR (WELLBUTRIN SR) · Bupropion XL 450 mg (FORFIVO XL)
Available combined with: dextromethorphan / bupropion · naltrexone / bupropion
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityDose-related seizures and delayed cardiotoxicity are prominent in overdose, especially with extended-release products.
Active metabolites
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