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Wellbutrin XL

(bupropion XL)

Full Prescribing Information DailyMed Drug Information

Forms/Strengths

  • Extended-release (XL): 150 mg, 300 mg

Dosing

  • Age: 
  • Onset: ~60 min
  • Duration: 8-12 hours

  • Considerations: Monitor for neuropsychiatric symptoms, especially in children and adolescents.

  • Initial Dose: 150 mg once daily
  • Titration: Increase to 300 mg once daily after 3 days if tolerated
  • Max Dose: 450 mg/day

Quick Facts

  • Inhibits reuptake of dopamine and norepinephrine; improves mood and energy
  • Extended-release formulation for once-daily dosing and stable plasma levels
  • Unique antidepressant profile; fewer sexual side effects and weight neutral
  • Common side effects: dry mouth, insomnia, headache, nausea
  • Caution: increased seizure risk at high doses or in susceptible individuals

Indications

  • Major depressive disorder (ICD-10: F32, F33)
  • Seasonal affective disorder (ICD-10: F33.0)
  • Smoking cessation (ICD-10: Z72.0)

Off-Label Uses

  •  Attention-deficit/hyperactivity disorder (ADHD) (ICD-10: F90.0)

How to Take

  • Take once daily in the morning at the same time each day.
  • Can be taken with or without food; taking with food may help reduce nausea.
  • Swallow the tablet whole; do not crush, chew, or split.
  • Avoid taking close to bedtime, as it may cause insomnia.
  • Do not abruptly stop taking; tapering may be required to prevent withdrawal effects.

Side Effects

  • Common: Insomnia, dry mouth, headache, nausea
  • Serious: Seizures, hypertension, neuropsychiatric symptoms

Monitoring / Labs

  • Blood pressure monitoring
  • Monitor for worsening depression or suicidal thoughts

Education

  • When to Call the Doctor:

    • Severe mood changes, aggression, or suicidal thoughts.
    • Unexplained seizures, confusion, or hallucinations.
    • Signs of allergic reaction (rash, itching, swelling, difficulty breathing).
    • Unusual bruising or bleeding.
    • Severe headache, blurred vision, or persistent nausea (signs of high blood pressure).

  • Safety Tips:

    • Monitor mood and behavioral changes, especially in patients with a history of depression or bipolar disorder.
    • Avoid alcohol, as it may increase the risk of seizures.
    • Use caution if you have a history of seizures, eating disorders, or head trauma, as Wellbutrin may lower the seizure threshold.
    • May cause dry mouth—increase hydration if needed.
    • Be cautious when driving or operating machinery until individual response is known.

  • Parent Tips for Pediatric Patients (if prescribed off-label):

    • Monitor for increased agitation, irritability, or changes in mood.
    • Be aware of appetite suppression—encourage balanced meals.
    • Observe for difficulty sleeping; discuss timing adjustments with the provider if needed.

Additional Information

  • Contraindications:

    • History of seizures or conditions that lower seizure threshold (e.g., eating disorders, head trauma, alcohol withdrawal).
    • Use within 14 days of MAOI therapy (risk of hypertensive crisis).
    • Severe hepatic impairment, as it may increase drug accumulation.

  • Pregnancy:

    • Category C; use only if benefits outweigh risks.
    • Limited human data, but potential risk for fetal harm is unclear.

  • Lactation:

    • Excreted in breast milk; use with caution as effects on the infant are unknown.

  • Drug Interactions:

    • CYP2B6 inhibitors (e.g., ticlopidine, clopidogrel) may increase Wellbutrin levels.
    • CYP2B6 inducers (e.g., carbamazepine, rifampin) may decrease effectiveness.
    • Other medications that lower seizure threshold (e.g., tramadol, antipsychotics, theophylline) may increase seizure risk.
    • Serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs) may increase the risk of serotonin syndrome.
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