# Wellbutrin XL ### (bupropion XL)
[**Full Prescribing Information**](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=a435da9d-f6e8-4ddc-897d-8cd2bf777b21&type=display)[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a435da9d-f6e8-4ddc-897d-8cd2bf777b21)
--- **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.