Home Drug Guide Bupropion Hydrochloride

Drug Guide

Generic Name

Bupropion Hydrochloride

Brand Names Wellbutrin, Wellbutrin SR, Zyban, Wellbutrin XL, Forfivo XL

Classification

Therapeutic: Antidepressant, Smoking Cessation Aid

Pharmacological: Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)

FDA Approved Indications

  • Depressive Disorders (Major Depressive Disorder, Dysthymia)
  • Seasonal Affective Disorder (SAD)
  • Prevention of Nicotine Dependence (smoking cessation)

Mechanism of Action

Bupropion inhibits the reuptake of norepinephrine and dopamine, increasing their levels in the synaptic cleft, which contributes to its antidepressant and smoking cessation effects.

Dosage and Administration

Adult: Typically 150 mg once daily, increased gradually to 300 mg/day in divided doses or as a single dose, depending on formulation and response.

Pediatric: Not typically used in pediatric patients.

Geriatric: Start with lower doses; monitor closely due to increased risk of side effects.

Renal Impairment: Dose adjustment recommended in severe impairment; consult prescribing information.

Hepatic Impairment: Use with caution; dose adjustment may be necessary.

Pharmacokinetics

Absorption: Well absorbed with peak plasma concentrations in 2 hours (immediate release).

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Extensively metabolized in the liver via hydroxylation and glucuronidation.

Excretion: Excreted mainly in urine; some in feces.

Half Life: Approximately 21 hours, allowing once-daily dosing in its extended-release formulation.

Contraindications

  • Seizure disorder
  • History of anorexia nervosa or bulimia
  • Abrupt discontinuation of alcohol or sedatives due to seizure risk
  • Concurrent use of other forms of bupropion
  • Use within 14 days of MAOI therapy

Precautions

  • Increased risk of seizures, neuropsychiatric symptoms, hypertension; monitor patients carefully.

Adverse Reactions - Common

  • Dry mouth ( Frequent)
  • Insomnia ( Frequent)
  • Sweating ( Frequent)
  • Nausea ( Frequent)

Adverse Reactions - Serious

  • Seizures ( Rare (dose-dependent))
  • Psychiatric symptoms (psychosis, hallucinations, worsening depression) ( Rare)
  • Hypertension ( Less common)

Drug-Drug Interactions

  • Other medications that lower seizure threshold (e.g., antipsychotics, theophylline)
  • MAOIs (must discontinue 14 days prior)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for seizure activity, psychiatric symptoms, blood pressure, dose response.

Diagnoses:

  • Risk for seizures
  • Risk for psychiatric adverse effects

Implementation: Start at lowest dose; titrate gradually; advise on avoiding alcohol and other medications that lower seizure threshold.

Evaluation: Monitor for adverse effects; assess mood improvements and smoking cessation progress.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any seizures, worsening mood, agitation, or unusual thoughts.
  • Avoid alcohol and sedatives.
  • Do not abruptly discontinue; consult provider before stopping.

Special Considerations

Black Box Warnings:

  • Increased risk of suicidal thinking and behavior in children, adolescents, and young adults.
  • Risk of seizure at doses exceeding 450 mg/day.

Genetic Factors: Pharmacogenetics may influence metabolism and response.

Lab Test Interference: May cause false positives for amphetamines on urine drug tests.

Overdose Management

Signs/Symptoms: Seizures, hallucinations, loss of consciousness, tachycardia, hypotension.

Treatment: Supportive care, seizure management, cardiopulmonary support, activated charcoal if appropriate, no specific antidote.

Storage and Handling

Storage: Store at room temperature, 20°-25°C (68°-77°F).

Stability: Stable for the duration of labeled expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.