Wellbutrin XL

(bupropion XL)

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.