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Wellbutrin(Wellbutrin SR, Wellbutrin XL, Bupropion, Budeprion SR, Zyban)
Wellbutrin Use
Wellbutrin - Antidepressant (norephinephrine/dopamine reuptake inhibitor). Adults, 100 to 150 mg once daily. In patients unresponsive to a dose of 150 mg/day, the dose may be increased, at intervals of at least 1 week, to a maximum of 300 mg/day. Wellbutrin doses > 150mg/day should be given twice daily, preferably with at least 8 hours between successive doses. Severe hepatic impairment: If Wellbutrin's use is deemed necessary, initiate therapy at a reduced dose, to a maximum dose of 100 mg every day or 150 mg every other day. Wellbutrin's effectiveness in long-term use (> 8 weeks) has not been systematically evaluated in controlled trials.
Wellbutrin Contraindications
Concomitant therapy with other bupropion-containing medications (e.g. Zyban). Patients with a current seizure disorder; with a current or prior diagnosis of bulimia or anorexia nervosa; undergoing abrupt withdrawal from alcohol or benzodiazepines or other sedatives. Not for concomitant use with MAOIs or thioridazine. Allow at least 14 days between the discontinuation of an MAOI or thioridazine and Wellbutrin initiation.
Wellbutrin Precautions
Discontinue Wellbutrin if allergic or anaphylactoid/anaphylactic or hypersensitivity reactions occur. Wellbutrin use is associated with a dose-dependent risk of seizures (the prescribed doses should not be exceeded) as well as predisposing factors (e.g. CNS tumour, prior seizures), clinical situations (e.g. OTC stimulant use, excessive use of alcohol) and concomitant use of medications known to lower the seizure threshold. Renal or hepatic impairment: monitor patients closely for possible side effects indicative of high drug and metabolite levels. Suicidal tendencies in seriously depressed patients, activation of psychosis and/or mania, various neuropsychiatric phenomena, agitation and insomnia. Dose-related weight loss. Hypertension, in some cases severe, requiring acute treatment in patients receiving bupropion alone and in combination with nicotine replacement therapy. These events have occurred in both patients with and without evidence of pre-existing hypertension. Pregnancy: weigh potential benefit vs. potential risk. Lactation: discontinue nursing or discontinue bupropion. Safety/efficacy in patients < 18 years of age not established. Geriatrics: exercise care in dose selection and monitor renal function.
Wellbutrin Side effects
Headache, constipation, dry mouth, nausea, dizziness, insomnia, tremor, tinnitus. Arthralgia, myalgia and fever in association with rash and other symptoms suggestive of delayed hypersensitivity which may resemble serum sickness.
Wellbutrin Interactions
Decreased Wellbutrin effect: carbamazepine, phenytoin, Phenobarbital. Increased bupropion level: cimetidine. Increased adverse reactions, seizures: most antidepressants (SSRIs, many tricyclics); beta-blockers (e.g., metoprolol), antipsychotics (e.g., risperidone, haloperidol), Type IC antiarrhythmics (e.g., flecainide), levodopa, amantadine, quinolone antibiotics, theophylline, lithium, systemic steroids.
Wellbutrin Supplied
100 mg, 150 mg sustained-release tablets.
Wellbutrin Description
Antidepressant
Wellbutrin is supplied for oral administration as 75 mg (yellow-gold) and 100 mg (red) film-coated tablets. Each tablet contains the labeled amount of bupropion hydrochloride and the inactive ingredients: 75 mg tablet - D&C Yellow No. 10 Lake, FD&C Yellow No. 6 Lake, hydroxypropyl cellulose, hydroxypropyl methylcelluose, microcrystalline cellulose, polyethylene glycol, talc, and titanium dioxide; 100 mg tablet - FD&C Red No. 40 Lake, FD&C Yellow No. 6 Lake, hydroxypropyl cellulose, hydroxypropyl methylcellulose, microcrystalline cellulose, polyethylene glycol, talc, and titanium dioxide.
Wellbutrin - Indications And Usage
Wellbutrin is indicated for the treatment of depression. A physician considering Wellbutrin for the management of a patient's first episodes of depression should be aware that the drug may cause generalized seizures with an approximate incidence of 0.4% (4/1000). This incidence of seizures may exceed that of other marketed antidepressants by as much as fourfold. This relative risk is only an approximate estimate because no direct comparative studies have been conducted.
Major Depression implies a prominent and relatively persistent depressed or dysphoric mood that usually interferes with daily functioning (nearly every day for at least 2 weeks); it should include at least four of the following eight symptoms: change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigability, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and suicidal ideation or attempts.
Effectiveness of Wellbutrin in long-term use, that is, for more than 6 weeks, has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use bupropion for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.
Wellbutrin Contraindications
Wellbutrin is contraindicated in patients with a seizure disorder. Wellbutrin is also contraindicated in patients with a current or prior diagnosis of bulimia or anorexia nervosa because of a higher incidence of seizures noted in such patients treated with Wellbutrin. The concurrent administration of Wellbutrin and a monoamine oxidase (MAO) inhibitor is contraindicated. At least 14 days should elapse between discontinuation of an MAO inhibitor and initiation of treatment with Wellbutrin. Bupropion is contraindicated in patients who have shown an allergic response to it.
Wellbutrin Precautions
Agitation and Insomnia: A substantial proportion of patients treated with Wellbutrin experience some degree of increased restlessness, agitation, anxiety, and insomnia, especially shortly after initiation of treatment. In clinical studies, these symptoms were sometimes of sufficient magnitude to require treatment with sedative/hypnotic drugs. In approximately 2% of patients, symptoms were sufficiently severe to require discontinuation of treatment with Wellbutrin.
Psychosis, Confusion, and Other Neuropsychiatric Phenomena: Patients treated with Wellbutrin have been reported to show a variety of neuropsychiatric signs and symptoms including delusions, hallucinations, psychotic episodes, confusion, and paranoia. Because of the uncontrolled nature of many studies, it is impossible to provide a precise estimate of the extent of risk imposed by treatment with bupropion. In several cases, neuropsychitric phenomena abated upon dose reduction and/or withdrawal of treatment.
Activation of Psychosis and/or Mania: Antidepressants can precipitate manic episodes in Bipolar Manic Depressive patients during the depressed phase of their illness and may activate latent psychosis in other susceptible patients. Wellbutrin is expected to pose similar risks.
Altered Appetite and Weight: A weight loss of greater than 5 pounds occurred in 28% of patients receiving Wellbutrin. This incidence is approximately double that seen in comparable patients treated with tricyclics or placebo. Furthermore, while 34.5% of patients receiving tricyclic antidepressants gained weight, only 9.4% of patients treated with Wellbutrin did. Consequently, if weight loss is a major presenting sign of a patient's depressive illness, the anorectic and/or weight reducing potential of bupropion should be considered.
Wellbutrin - Information for Patients
Physicians are advised to discuss the following issues with patients:
Patients should be instructed to take Wellbutrin in equally divided doses three or four times a day to minimize the risk of seizure.
Patients should be told that any CNS-active drug like Wellbutrin may impair their ability to perform tasks requiring judgment or motor and cognitive skills. Consequently, until they are reasonably certain that Wellbutrin does not adversely affect their performance, they should refrain from driving an automobile or operating complex, hazardous machinery.
Patients should be told that the use and cessation of use of alcohol may alter the seizure threshold, and, therefore, that the consumption of alcohol should be minimized, and, if possible, avoided completely.
Patients should be advised to inform their physician if they are taking or plan to take any prescription or over-the-counter drugs. Concern is warranted because Wellbutrin and other drugs may affect each others metabolism.
Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy.
Wellbutrin - Drug Interactions
No systematic data have been collected on the consequences of the concomitant administration of bupropion and other drugs.
Wellbutrin Overdose
Since introduction, overdoses of Wellbutrin up to 17,500 mg have been reported. Seizure was reported in approximately one-third of all cases. Other serious reactions reported with overdoses of Wellbutrin alone included hallucinations, loss of consciousness, and tachycardia. Fever, muscle rigidity, rhabdomyolysis, hypotension, stupor, coma, and respiratory failure have been reported when Wellbutrin was part of multiple drug overdoses.
Wellbutrin - Management of Overdose
Following suspected overdose, hospitalization is advised. If the patient is conscious, vomiting should be induced by syrup of ipecac. Activated charcoal also may be administered every 6 hours during the first 12 hours after ingestion. Baseline laboratory values should be obtained. Electrocardiogram and EEG monitoring also are recommended for the next 48 hours. Adequate fluid intake should be provided.
Wellbutrin Supplied
Bupropion hydrochloride tablets are supplied as 75 mg (yellow-gold) round, biconvex tablets printed "WELLBUTRIN" and "75", bottles of 100 (NDC 0081-0177-55); and 100 mg(red) round, biconvex tablets printed "WELLBUTRIN" and "100", bottles of 100 (NDC 0081-0178-55).
Wellbutrin Storage
Store Wellbutrin at 15° to 25°C (59° to 77°F). Protect from light and moisture.
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