Bupropion
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Trade Name
Wellbutrin (depression: IR, SR, XL); Zyban (smoking cessation); generic bupropion hydrochloride
Classification
Atypical antidepressant; norepinephrine-dopamine reuptake inhibitor (NDRI)
Dosage/Route
- * Dosage:
- – Immediate-release (IR): 75 mg, 100 mg tablets
- – Sustained-release (SR): 100 mg, 150 mg, 200 mg tablets
- – Extended-release (XL): 150 mg, 300 mg, 450 mg tablets
- * Route: Oral (PO)
Usual Dosage
- * Depression:
- – IR: 100 mg PO BID-TID; max 450 mg/day (≤150 mg/dose)
- – SR: 150 mg PO daily, then BID; max 400 mg/day (≤200 mg/dose)
- – XL: 150 mg PO daily, increase to 300 mg/day; max 450 mg/day
- * Smoking Cessation (Zyban): 150 mg PO daily for 3 days, then 150 mg BID; max 300 mg/day
- * Start low, titrate over weeks; space doses ≥4 hr (IR) or ≥8 hr (SR)
Mechanism of Action
Inhibits reuptake of norepinephrine and dopamine in the CNS, increasing their availability. Lacks significant serotonin effects (unlike SSRIs). Boosts mood, energy, and motivation; reduces nicotine cravings via dopamine modulation
Side Effects & Adverse Effects
- * Side Effects: Dry mouth, insomnia, headache, agitation, weight loss
- * Adverse Effects:
- – Seizures (boxed warning; dose-dependent, esp. >450 mg/day or in bulimia/anorexia)
- – Hypertension (monitor BP, esp. with nicotine patches)
- – Psychosis/mania (rare; high doses or bipolar history)
- – Suicidality (early treatment, young adults)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor seizure risk (history, dose adherence); avoid in epilepsy/bulimia
- – Assess BP baseline/periodically; mood (suicide risk early on)
- – SR/XL: Don’t crush/chew (seizure risk from rapid release)
- – Avoid with MAOIs (within 14 days) or alcohol (lowers seizure threshold)
- * Teachings:
- – Take early in day (avoid bedtime to prevent insomnia)
- – Report seizures, fast heartbeat, or mood swings
- – Avoid alcohol/caffeine (increases side effects)
- – Smoking cessation: Set quit date 1-2 weeks after starting
Indication for This Patient
- * Major depressive disorder (MDD)
- * Seasonal affective disorder (SAD) (XL form)
- * Smoking cessation (Zyban; adjunct to counseling)
Time
- * Timing: IR: BID-TID; SR: BID (morning/evening); XL: once daily (morning)
- * Onset: Mood improvement in 1-4 weeks; smoking aid effect in 1-2 weeks
- * Peak: IR: 2 hr; SR: 3 hr; XL: 5 hr
- * Duration: IR: 6-12 hr; SR: 12-18 hr; XL: 24 hr
