Wellbutrin

Wellbutrin SR (bupropion hydrochloride) is a second-generation antidepressant and aminoketone-class medication specifically formulated with sustained-release technology. This formulation provides stable plasma concentrations over a 12-hour dosing interval, offering clinicians a valuable therapeutic option with a distinctive neuropharmacological profile. Unlike many serotonin-based antidepressants, Wellbutrin SR primarily acts as a norepinephrine-dopamine reuptake inhibitor (NDRI), making it particularly suitable for patients who experience undesirable effects with other antidepressant classes or require alternative mechanisms of action. Its well-characterized pharmacokinetic profile and favorable side effect spectrum have established it as a cornerstone in depression management protocols.

Features

• Contains bupropion hydrochloride as active ingredient (100mg or 150mg strengths)
• Sustained-release tablet formulation for twice-daily dosing
• NDRI mechanism targeting norepinephrine and dopamine reuptake inhibition
• Minimal serotonergic activity
• Bioavailability approximately 87% with peak plasma concentrations at 3 hours
• Mean elimination half-life of 21 hours (± 9 hours)
• Hepatic metabolism via CYP2B6 with three active metabolites

Benefits

• Provides sustained mood stabilization without significant weight gain commonly associated with other antidepressants
• Demonstrates lower incidence of sexual dysfunction compared to SSRIs and SNRIs
• Offers effective depression management with minimal sedation or cognitive impairment
• May improve energy levels and motivation through dopaminergic activity
• Suitable for long-term maintenance therapy with established safety profile
• Provides alternative mechanism for treatment-resistant depression cases

Common use

Wellbutrin SR is primarily indicated for the treatment of major depressive disorder (MDD) in adults. Healthcare providers may also prescribe it off-label for seasonal affective disorder (SAD) and as an adjunct for smoking cessation, though the latter indication typically utilizes the bupropion hydrochloride formulation marketed specifically for this purpose. The medication demonstrates particular utility in cases where patients have experienced unsatisfactory results with selective serotonin reuptake inhibitors (SSRIs) or where the side effect profiles of other antidepressants prove problematic. Clinical studies have established its efficacy in both acute phase treatment and maintenance therapy for depression, with response rates comparable to other first-line antidepressants while offering a differentiated side effect profile.

Dosage and direction

The recommended starting dosage for Wellbutrin SR is 150mg once daily for the first three days, typically administered in the morning. Based on clinical response and tolerability, the dosage may be increased to 150mg twice daily, with at least 8 hours between doses to minimize the risk of dose-related adverse effects. The maximum recommended dose is 400mg per day, administered as 200mg twice daily. Dosage adjustments should be made gradually, with increments occurring no more frequently than every 3-4 days based on clinical assessment. Tablets should be swallowed whole and not crushed, chewed, or divided, as this would compromise the sustained-release properties and potentially lead to rapid drug release and increased adverse effects. Administration with food may help minimize potential gastrointestinal discomfort.

Precautions

Patients should be monitored closely for clinical worsening, suicidality, or unusual changes in behavior, particularly during the initial months of therapy or following dosage adjustments. Wellbutrin SR lowers the seizure threshold in a dose-dependent manner, with the incidence increasing significantly at doses above 450mg daily. Caution is advised in patients with history of seizure disorder, cranial trauma, or conditions predisposing to seizures. Hepatic impairment necessitates dosage reduction, as bupropion undergoes extensive liver metabolism. Renal impairment requires careful monitoring and potential dosage adjustment. Elderly patients may experience increased sensitivity to side effects. Blood pressure monitoring is recommended, as hypertension has been reported. Patients should avoid alcohol consumption during treatment, as this may increase seizure risk and potentially worsen depression.

Contraindications

Wellbutrin SR is contraindicated in patients with seizure disorder or history of epilepsy. It must not be used in individuals with current or prior diagnosis of bulimia or anorexia nervosa due to increased seizure risk. Concomitant use with monoamine oxidase inhibitors (MAOIs) is contraindicated, requiring a minimum 14-day washout period between therapies. Hypersensitivity to bupropion or any tablet components prohibits use. The medication is contraindicated in patients undergoing abrupt discontinuation of alcohol or sedatives, including benzodiazepines. Those with known hepatic impairment severe enough to affect metabolic capacity should not receive this medication without careful risk-benefit assessment and dosage modification.

Possible side effect

The most commonly reported adverse reactions (occurring in >5% of patients) include dry mouth, nausea, insomnia, headache, constipation, and dizziness. Approximately 25-30% of patients experience initial weight loss of 2.5-4 kg, which typically stabilizes over continued treatment. Tremor, agitation, anxiety, and sweating occur in 5-10% of patients, often dose-related and frequently transient. Tinnitus, blurred vision, and tachycardia have been reported in 2-5% of cases. The incidence of sexual dysfunction is notably lower than with SSRIs, occurring in approximately 3-5% of patients. Seizures occur in approximately 0.1% of patients at doses ≤300mg daily and 0.4% at 400mg daily. Rare but serious side effects include severe hypersensitivity reactions, angle-closure glaucoma, and psychotic or manic episodes.

Drug interaction

Wellbutrin SR demonstrates significant interactions with medications metabolized by CYP2D6, as bupropion and its metabolites inhibit this enzyme system. Dose adjustment may be necessary for concomitant drugs including certain beta-blockers, antipsychotics, Type 1C antiarrhythmics, and some antidepressants. Concurrent administration with MAOIs is contraindicated. Drugs that lower seizure threshold (other antidepressants, antipsychotics, corticosteroids, theophylline, systemic steroids) require careful risk assessment. CYP2B6 inhibitors (clopidogrel, ticlopidine) may increase bupropion exposure, while inducers (carbamazepine, phenobarbital, ritonavir) may decrease efficacy. Levodopa and amantadine require cautious co-administration due to dopaminergic effects. Nicotine replacement therapy may potentiate hypertensive effects.

Missed dose

If a dose is missed, the patient should take it as soon as remembered, unless it is closer to the time of the next scheduled dose. In such cases, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should never double the dose to make up for a missed administration, as this significantly increases the risk of adverse effects, including seizures. If multiple doses are missed, consultation with the prescribing healthcare provider is recommended before resuming therapy, as dosage adjustment or re-titration may be necessary. Consistent timing of administration helps maintain stable plasma concentrations and optimal therapeutic effect.

Overdose

Bupropion overdose presents significant medical risk, with seizures occurring in approximately one-third of cases. Other manifestations include hallucinations, loss of consciousness, sinus tachycardia, ECG changes (QRS widening, QT prolongation), and hyperthermia. Fatal outcomes have been reported, particularly with large ingestions exceeding 4-5 grams. Management requires immediate medical attention with supportive care, including securing airway, monitoring cardiac function, and managing seizures with benzodiazepines. Gastric lavage may be considered if presentation occurs within 1-2 hours of ingestion. Activated charcoal may be administered if the patient presents early and airway protection is ensured. There is no specific antidote; treatment remains symptomatic and supportive. Continuous cardiac monitoring for at least 24 hours is recommended due to potential delayed effects.

Storage

Wellbutrin SR tablets should be stored at controlled room temperature (20-25°C or 68-77°F) with excursions permitted between 15-30°C (59-86°F). The medication must be kept in its original container with the lid tightly closed to protect from moisture and light. Tablets should not be stored in bathroom cabinets or other areas subject to high humidity. Keep all medications out of reach of children and pets. Proper disposal of expired or unused medication is essential, preferably through medication take-back programs or by mixing with undesirable substance (such as coffee grounds or kitty litter) in a sealed container before discarding in household trash. Do not flush medications unless specifically instructed to do so.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to Wellbutrin SR may vary based on numerous factors including genetics, concomitant medications, and underlying health conditions. Treatment decisions must be made by qualified healthcare professionals based on comprehensive patient assessment. The prescribing information provided here represents general guidelines, and clinicians should consult the full prescribing information and latest clinical research when making treatment decisions. Patients should not initiate, adjust, or discontinue medication without professional medical supervision.

Reviews

Clinical studies demonstrate Wellbutrin SR’s efficacy with response rates of 60-70% in major depressive disorder, comparable to other antidepressants but with differentiated tolerability profile. Meta-analyses indicate particularly favorable outcomes regarding weight neutrality and sexual side effects compared to SSRIs. Long-term maintenance studies show sustained efficacy with 40-50% lower relapse rates versus placebo over 12-month periods. Patient-reported outcomes frequently note improvements in energy, motivation, and cognitive function, though individual experiences vary considerably. The medication receives consistently high physician satisfaction scores for patients who have failed previous antidepressant therapies or require alternative mechanisms of action. Real-world evidence supports its position as a valuable option in the antidepressant armamentarium.